RU2772540C1 - Method for treating patients with dental discolouration - Google Patents

Abstract

FIELD: dentistry.

SUBSTANCE: claimed invention relates to the field of medicine, namely, to dentistry, and is intended for use in treating patients with dental discolouration. The initial prognosis of the development of the disease is made, including, in turn, collection of the anamnesis, dental examination, identification of the value of the CPI index, the level of hygiene, cariogenicity of the dental plaque, and assessment of the condition of the surface of the teeth, followed by planning the treatment. Planning is conducted in an automated mode using a computer-implemented method for planning the treatment of patients with dental discolouration, according to which, patient data is retrieved from the electronic medical record, from at least one patient, complaints from the patient and the anamnesis, including life history, indexes for determining the condition of teeth, and identification of possible causes of discolouration, are entered into the medical record. Life history therein includes information on bad habits of the patient, their diet, past illnesses, epidemiological anamnesis, occupational anamnesis, allergic anamnesis, long-term use of medicinal products in the past 2 years and chronic diseases, and the indexes for determining the condition of teeth include the hygiene index, the gingival index, the bleeding index, the parodontal index, the CPI index, the index of oral hygiene efficiency, the index of intensity of dental hyperesthesia, and the index of advancement of dental hyperesthesia. The possible causes of discolouration therein include information on carious damage of the teeth, traumatic damage of the teeth, endodontal treatment and non-carious damage of the teeth in the form of fluorosis, hypoplasia, amelogenesis imperfecta, tetracycline staining of the teeth, dentinogenesis imperfecta, or a wedge-shaped defect. After collecting all the required information, the patient in an automated mode is issued preliminary recommendations before treatment, including the measures required to begin treatment and the information on the medical grounds for bleaching, after following the recommendations, the patient can begin treatment, the procedure whereof is also issued in an automated mode to the attending physician. In case of a positive prognosis, bleaching is performed; for this purpose, a mouth expander, containing a rounded inner frame, an external lip protection part, an internal part for protecting the mucous membrane of the cheeks, and a tongue retainer in the form of a bending strap connected with the inner part for protecting the mucous membrane of the cheeks and passing through the retromolar region along the side surfaces of the tongue, is preliminarily placed in the oral cavity. The strap therein has an extension in the area of the tip of the tongue, wherein the inner frame, the external lip protecting part, and the internal part for protecting the mucous membrane of the cheeks of the mouth expander are made of nitrile, and the tongue retainer is made of plastic. The teeth are then coated with a fluoroplastic sealing material, followed by applying a composition on the surface of the marginal gingiva and the area of the interdental papillae by directional aerosol spraying in several pulses, at the following ratio of components, wt.%: sodium ascorbate 11; polyvinyl pyrrolidone 15; distilled water 73.8; food flavouring 0.2. The composition is allowed to dry until a film is formed, then the film is coated with liquid rubber dam, a bleaching gel is applied, and a bleaching procedure is performed, then highly concentrated substances are removed from the surface of the teeth by means of a bleaching gel aspiration tool comprising a working part in the form of a hollow tube consisting of a larger-diameter part and a curved smaller-diameter part, wherein the curved smaller-diameter part is configured for installing a detachable disposable hollow attachment made of an elastic material, attached in the upper part whereof is a non-traumatic sponge with a hole.

EFFECT: timely detection of the development of dental discolouration and selection of the procedure of further treatment, which ensures a safe therapeutic process.

1 cl, 3 dwg, 6 tbl, 1 ex

Description

The claimed technical solution relates to the field of medicine, namely to dentistry, and can be used to treat patients with discolored teeth.

A known method of teeth whitening (patent No. 2608441, IPC A61Q 11/00, A61K 33/40, A61P1/02, publ. 01/18/2017), which includes the step of (i) applying an effective amount of an oral care composition to the teeth containing a bleaching agent, and allowing this composition to remain on the teeth for 45 to 90 seconds. Step (ii) is then carried out by brushing the teeth with the same composition. At the same time, the bleaching agent is hydrogen peroxide in complex with polyvinylpyrrolidone, and the concentration of said bleaching agent in the composition is equivalent to 0.1-5% hydrogen peroxide. In addition, the composition contains an abrasive substance with calcium.

The disadvantage of this method is the lack of development of preliminary treatment tactics, as well as the lack of additional protection of the gums when brushing your teeth.

A known method for protecting the gums (patent No. 2673371, IPC A61C 19/00, publ. 11/26/2018), according to which the two-component silicone impression mass is mixed until a homogeneous mass is obtained and injected into each interdental space using a disposable syringe . The mass hardens within 1-2 minutes in the interdental spaces. The teeth are splinted, after which the hardened impression mass is removed from the interdental spaces using a probe or tweezers.

The disadvantage of this method is the difficulty of covering the silicone mass of hard-to-reach areas in the area of interdental gingival papillae.

Also known is a liquid rubber dam and a method for its application (https://shop.dentomir.ru/files/Zhvdkii_Kofferdam.pdf), according to which a rubber dam is applied, consisting of a light-cured polymer composition, barium-aluminum-borosilicate glass, aerosil and methylene blue.

The disadvantages of this solution are the difficulty of gel coating hard-to-reach areas in the area of interdental gingival papillae, as well as accidental ingress of oral fluid or water on the surface of the liquid rubber dam weakens adhesion to the underlying tissues, which leads to leakage of the whitening gel.

The closest analogue is a method for predicting pulpitis of temporary teeth in children using a clinical and biochemical rating scale (patent No. 2680592, IPC A61B 5/00, G01N 33/48, publ. examination, laboratory biochemical studies of oral fluid and blood. Indicators of the general health of the child are revealed - prenatal history, the number of points on the Apgar scale at birth, the type of feeding, the level of resistance of the organism, the somatic history of the child. Identifies indicators of diet and sugar load. Dental status indicators are revealed - the value of the KPU index, the level of hygiene, the cariogenicity of dental plaque. The biochemical indicators of the oral fluid are revealed - the level of secretory immunoglobulin sIgA, the value of the phosphorus-calcium coefficient and alkaline phosphatase. Blood biochemical parameters are revealed - the content of ionized calcium and 25(OH)D in the blood serum. Prognostic indicators are evaluated in points. The scores obtained are summed up. With a total of 5-11 points, a low degree of risk is predicted. With a total of 12-20 points - the average degree of risk. With a total of 21-29 points - a high degree of risk. With a sum above 30 points - a very high risk of developing pulpitis of temporary teeth in children.

The main disadvantage of this method is its narrow focus, affecting the development of temporary teeth in children, and it also does not allow the patient to provide further treatment tactics.

The task to be solved by the claimed technical solution is the timely detection of the development of discoloration of the teeth, the choice of tactics for further treatment and effective therapy using optimal methods of treatment.

The technical result of the invention is to increase the speed of diagnosis, while providing an improvement in the quality of treatment of patients with discolored teeth due to the automatic choice of treatment tactics based on a detailed analysis of the patient's condition and relevant influencing factors, as well as ensuring a safe therapeutic process.

This technical result is achieved due to the fact that according to the method of treating patients with discoloration of the teeth, which consists in the initial prediction of the development of the disease, which, in turn, includes taking an anamnesis, a dental examination, identifying the value of the KPU index, the level of hygiene, the cariogenicity of plaque and assessing the condition of the surface of the teeth with subsequent treatment planning, planning is carried out in an automated mode using a computer-implemented method for planning the treatment of patients with discolored teeth, according to which the patient’s basic data are obtained from the electronic medical record from at least one patient, the patient’s complaints are entered into the medical record and an anamnesis of the disease, which includes an anamnesis of life, indices for determining the condition of the teeth and identification of possible causes of discoloration of the teeth (discoloration), and the anamnesis of life is information about the patient's bad habits, his diet, transferred diseases, epidemiological history, work history, allergic history, long-term use of drugs over the past 2 years and chronic diseases, and indices for determining the condition of the teeth include the hygiene index - IGR-U (Green-Vermillion), the gingival index - GI (Loe, Strength ), bleeding index - SBI (Muhlemann - Cowell), periodontal index (Russel), KPU index, oral hygiene efficiency index - RHP, tooth hyperesthesia intensity index (IIGI) and dental hyperesthesia prevalence index (DTI), with possible causes of discoloration teeth (discoloration) include information about carious lesions of teeth, traumatic damage to teeth, endodontic treatment, and non-carious lesions of teeth in the form of fluorosis, hypoplasia, imperfect amelogenesis, tetracycline staining of teeth, imperfect dentinogenesis or wedge-shaped defect, after collecting all the necessary information for the patient in an automated mode issue a preliminary recommendation before treatment, which include the measures necessary to start treatment and information about the indications for whitening, after following these recommendations, the patient can begin treatment, the tactics of which are also automatically given to the attending physician, in case of a positive prognosis, whitening is performed, for this, first a mouth expander is placed in the oral cavity, containing an inner rounded frame, an outer part to protect the lips, an inner part to protect the buccal mucosa and a tongue retainer in the form of a curving strap connected to the inner part to protect the buccal mucosa and passing through the retromolar region along the side surfaces tongue, and in the region of the tip of the tongue, the strap has an extension, while the inner frame, the outer part to protect the lips and the inner part to protect the buccal mucosa of the mouth expander are made of nitrile, and the tongue retainer is made of plastic, then the teeth are covered with a fluoroplastic sealing material, after which on the surface of the marginal gums and the area of interdental papillae by means of directional aerosol spraying with several pulses, the composition is applied, in the following ratio of components, wt. %: sodium ascorbate - 11; polyvinylpyrrolidone - 15; distilled water - 73.8; food flavors - 0.2, allow the composition to dry until a film is formed, and then cover the film with a liquid rubber dam, apply a whitening gel and perform a whitening procedure, then remove highly concentrated substances from the surface of the teeth using a whitening gel aspiration tool, which contains the working part in the form a hollow tube consisting of a part of a larger diameter and a bent part of a smaller diameter, wherein the bent part of a smaller diameter is made for mounting a removable disposable hollow nozzle made of elastic material, on the upper part of which an atraumatic sponge with a hole is attached.

The collection of anamnesis, preliminary recommendations before treatment, and the very tactics of treating patients with discoloration of teeth are performed automatically, which significantly increases the speed of diagnosis and treatment.

Collection of a detailed anamnesis of the patient's life in conjunction with indices for determining the condition of the teeth and information about the possible causes of discoloration of the teeth (discoloration) can significantly improve the quality of treatment of patients with discoloration of the teeth by taking into account all kinds of influencing factors.

A safe therapeutic process is ensured through the use of an oral soft tissue protector, a mouth expander and a specially designed whitening gel aspiration tool during the teeth whitening procedure and the prevention of periodontal disease.

The technical essence of the proposed technical solution is illustrated by the following drawings.

In FIG. 1 shows a diagram of the operation of a computer-implemented method for planning the treatment of patients with discolored teeth.

In FIG. 2 shows the design of the expander.

In FIG. 3 shows the design of the whitening gel aspiration tool.

The method for treating patients with discolored teeth includes planning treatment tactics, which is carried out in an automated mode using a computer-implemented method for planning the treatment of patients with discolored teeth, preparing for safe treatment, which consists in placing a mouthpiece in the oral cavity, covering the teeth with a fluoroplastic sealing material, aerosol application of a protective composition, coating the formed film with a liquid rubber dam, carrying out a whitening procedure and carrying out a procedure for removing highly concentrated substances from the surface of the teeth using a whitening gel aspiration tool.

The mouth expander is an inner frame (1) of a rounded shape with a flexible plate (2) and an outer frame (3) of a rounded shape. On the right and left, the inner frame (1) continues with an inner part to protect the buccal mucosa, which is flat elastic plates (4), between which a tongue retainer (5) is installed in the form of a curved strap with an extension (6). The extension (6) has a wide front and a wide top that also covers the top surface of the tongue. The latch (5) has elongated parts (7), by means of which it is connected to the inner surfaces of the elastic plates (4), and the ends of these parts are rigidly attached to the inner frame (1). In the region of the upper vestibule of the oral cavity, a notch (8) is made for the frenulum of the upper lip. The inner frame (1), the outer lip protector (2, 3) and the inner buccal mucosal protector (4) of the mouthpiece are made of nitrile. The tongue holder (5) is made of plastic.

The protective composition includes the following ratio of components, wt. %:

sodium ascorbate eleven polyvinylpyrrolidone fifteen distilled water 73.8 food flavorings 0.2

This aerosol has properties that prevent burns in the previously mentioned cases and improve the adhesion of liquid rubber dam, which reduces the likelihood of penetration of the bleaching gel. The composition does not adversely affect the final result of office teeth whitening, does not stain the hard tissues of the teeth, does not cause allergic reactions, does not have a sharp taste or smell that promotes increased salivation.

The whitening gel aspiration tool contains a working part in the form of a hollow tube, which smoothly increases its diameter, thus forming a part of a larger diameter (9) and a part of a smaller diameter (10), as well as an elastic nozzle (11) mounted on parts of a smaller one. diameter (10). The narrow part (10) has a curve, which makes it possible to reach hard-to-reach areas of the oral cavity. An atraumatic sponge (12) with a hole (13) is fixed on the upper part of the elastic nozzle.

The technical solution can be implemented using an electronic computer and any other devices capable of performing a given, well-defined sequence of operations.

From an electronic medical record, at least one patient receives patient data according to the following parameters: last name, first name, patronymic, gender, date of birth, address of residence, contact number, place of work and date of the patient's visit to the clinic. If the patient came to the appointment for the first time, he gets his own electronic medical record. All data of an electronic medical record can come from various sources of information: questionnaires (questionnaires, diaries), personal medical devices, results of a medical examination, results of laboratory tests, conclusions of medical consultants. The patient’s complaints are also entered into the medical record (the reason for the visit, whether the treatment was carried out earlier, what result the patient wants to receive) and the medical history, which includes an anamnesis of life, indices for determining the condition of the teeth and identifying possible causes of discoloration of the teeth (discoloration). After collecting all the necessary information, the patient is automatically given preliminary recommendations before treatment. After following these recommendations, the patient can begin treatment. Treatment tactics are also automatically issued to the attending physician and the patient.

The anamnesis of life includes information about the patient's bad habits, his diet, previous diseases, epidemiological history, work history, allergic history, long-term use of drugs over the past 2 years, chronic diseases.

Bad habits of the patient: smoking, alcoholic beverages, drugs.

Diet: high carbohydrate diet (pasta, bread, fruits, oatmeal), tea or coffee abuse, seasonal berries, carbonated drinks, other (soy sauce, etc.).

Past diseases: hypovitaminosis, alkaptonuria, hemolytic anemia, impaired development of the biliary system, hemolytic disease of the newborn, congenital porphyria (Gunther's disease).

Labor history: work at a metallurgical enterprise (contact with tin, nickel, iron), work at a chemical enterprise (influence of strong acids, alkali).

Allergological history: allergy to components of bleaching systems (H2O2), allergy to anesthetic components (lidocaine, etc.), allergic reaction to ultraviolet radiation (sun), allergic reaction to latex products.

Long-term medication: taking tetracycline antibiotics (during odontogenesis or by the patient's mother), taking tin or fluoride preparations, hormonal drugs that cause bleeding, taking antibiotics (minocycline, chlorine tetracycline, oxytetracycline).

Chronic diseases: hyperthyroidism, anemia, hemolytic anemia, sickle cell anemia, syphilis, rheumatism, hemolytic jaundice of newborns, phenylketonuria.

Indices for determining the condition of the teeth include: hygiene index IGR-U (Green-Vermillion), gingival index - GI (Loe, Silness), bleeding index - SBI (Muhlemann - Cowell), periodontal index (Russel), KPU index, PHP index, index intensity of hyperesthesia of teeth (IIHZ) and index of prevalence of hyperesthesia of teeth (IRHZ).

Hygiene index IGR-U (Green-Vermillion) is calculated by the formula:

where

OHI - D - plaque values;

OHI - C - tartar values.

Codes and criteria for assessing plaque and tartar are presented in tables 1.2.

Condition for OHI-S:

if ≥0.6 - "good hygiene";

if 0.7-1.6 - "hygiene is satisfactory";

if 1.7-2.5 - "poor hygiene";

if >2.6" hygiene is poor.

Gingival index - GI (Loe, Strength) is calculated by the formula:

where n is the number of examined teeth.

The criteria for assessing the gingival index are presented in Table 3.

Condition for GI:

if 0.1≤GI≤1.0 - "mild gingivitis";

if 1.1≤GI≤2.0 - "medium degree of gingivitis";

if 2.1≤GI≤3.0 - "severe degree of gingivitis" (relative contraindication).

Bleeding index - SBI (Muhlemann - Cowell) is calculated by the formula:

The condition of the gums is determined in the area of "Ramfjord's teeth" from the vestibular and oral sides using a bellied probe. The tip of the probe is pressed against the wall of the groove without pressure and slowly led from the medial to the distal side of the tooth.

The criteria for assessing the bleeding index are presented in Table 4.

Interpretation of SBI index values: 100-50% - severe generalized periodontal inflammation; 50-20% - the average degree of inflammation of the gums; 20-10% - mild inflammation of the gums.

Periodontal index (Russel) is calculated by the formula:

The criteria for assessing the periodontal index are presented in Table 5.

Condition for PI:

if 0.0-0.2 is the norm;

if 0.3-0.6 - simple gingivitis;

if 0.7-1.5 - initial periodontitis;

if 1.6-3.6 - developed periodontitis;

if 3.7-8.0 - the terminal stage of periodontitis.

The KPU index (K - the number of foci of caries; P - installed fillings; Y - removed (missing) teeth) is characterized by the sum of teeth with filling and caries.

Condition for KPU:

if 0 - 3 - the degree of resistance to caries is high;

if 4 - 6 - the degree of resistance to caries is average;

if 7 -17 - the degree of resistance to caries is low;

if 18 or more - the degree of resistance to caries is very low.

RHP index (index of effectiveness of oral hygiene). First, a dye solution is applied to the teeth, then the patient rinses his mouth with water, and 6 teeth are examined. At the same time, their surface is divided into 5 sections: medial, distal, mid-occlusal, central, mid-cervical. The absence of staining is determined by zero, and the presence is determined by one.

When calculating, the following formula is used: IG=ZN/n, where ZN is the sum of codes for all teeth; n is the number of examined teeth. At a value of 0, the state of the oral cavity is considered excellent, and at 1.7 or more - unsatisfactory.

The HIHI index is calculated by the formula: HIHI = Sum of each tooth index score / number of sensitive teeth.

The criteria for evaluating the IIHI index are presented in Table 6.

if 1.0-1.5 points hyperesthesia of the 1st degree;

if 1.6-2.2 points - II degree;

if 2.3-3.0 points - III degree.

The IRGZ index is calculated by the formula:

IRHZ = number of teeth with hypersensitivity * 100 / number of teeth in this patient

With IRGZ values of 3.1-25%, a localized form of hypersensitivity is diagnosed, with IRGZ of 26-100% - generalized.

Exceeding the allowable values of each of the indexes leads to a refusal to treat patients with discoloration of the teeth, namely:

- hygiene index IGR-U (1.7-2.5 - "poor hygiene" OR IGR-U> 2.6 "bad hygiene);

- gingival index - GI (2.1≤GI≤3.0 - "severe degree of gingivitis");

- bleeding index - SBI (100-50% severe generalized periodontal inflammation);

- periodontal index (if 3.7-8.0 - terminal stage of periodontitis);

- KPU index (18 or more - the degree of resistance to caries is very low);

- PHP index (1.7 and more - unsatisfactory);

- IIHZ index (2.3-3.0 points - III degree);

- IRGZ index (26-100% - generalized form of hypersensitivity).

Possible causes of discoloration of teeth (discoloration) can be: carious lesions of teeth, traumatic damage to teeth, previously endodontically treated tooth, non-carious lesions of teeth (fluorosis, hypoplasia, amelogenesis imperfecta, tetracycline staining of teeth, dentinogenesis imperfecta, wedge-shaped defect), other causes.

Carious lesions of the teeth: foci of demineralization were not identified; foci of demineralization with a low or medium degree of staining on molars, premolars; foci of demineralization with a low, medium or high degree of staining on all groups of teeth, except for the lower incisors; foci of demineralization with a low, medium or high degree of staining on all groups of teeth.

Traumatic damage to the teeth: acute trauma of the tooth (tooth bruise, dislocation of the tooth, fracture of the tooth, trauma to the rudiment of the tooth, combined trauma of the tooth); chronic tooth trauma (bad habits such as biting threads, etc., incorrect installation of a metal pin in the root canal, orthodontic treatment, occlusal trauma).

Fluorosis: spotted form, rough form, chalk-speckled form, erosive form, destructive form.

Hypoplasia: systemic (mild, moderate, severe), local (mild, moderate, severe).

After collecting all the necessary information, the patient is automatically given preliminary recommendations before treatment and treatment tactics.

Preliminary recommendations include preliminary measures necessary to start treatment and information about the indications for whitening. Perhaps at this stage it will be clear that whitening is contraindicated. After following these recommendations, the patient can begin treatment. Treatment tactics are also automatically issued to the attending physician and the patient. If it is necessary to carry out bleaching, a preparation procedure is carried out, which consists in placing the mouth expander in the oral cavity, covering the teeth with a fluoroplastic sealing material, spraying a protective composition and covering the formed film with a liquid rubber dam. Then carry out the procedure of bleaching. The final step is to remove highly concentrated substances from the surface of the teeth using a whitening gel aspiration tool. An example of the implementation of the method.

After collecting all the necessary information about the patient and entering all the data into the database of the electronic computer, preliminary recommendations are issued. Due to the fact that at the stage of identifying a possible cause of discoloration of teeth (discoloration), the following was chosen:

- fluorosis (spotted form or rough form);

AND KPU<6; And the effectiveness of hygiene (РНР=0 or 0.1<РНР<0.6 or 0.7<РНР<1.6), the following conclusion was made - "Microabrasion or microabrasion followed by bleaching with the obligatory appointment of a course of preliminary remineralizing therapy without fluoride containing preparations.

After that, also in an automated mode, a treatment tactic is issued: “It is recommended to carry out two microabrasion procedures with an interval of a week or a combination of microabrasion, preliminary remineralizing therapy and whitening. with calcium", SensodyneC, Oral-BSensetive, R.O.C.S. medical minerals, GC Tooth mousse) and rinse with 5% hydroxyapatite or 10% calcium gluconate solution."

According to the treatment tactics, microbiology and whitening procedures are performed. For the safe implementation of these procedures, the mouth expander is first placed in the oral cavity, the teeth are covered with a fluoroplastic sealing material, a protective composition is applied, and the formed film is covered with a liquid rubber dam. Then carry out the procedure of bleaching. The final step is to remove highly concentrated substances from the surface of the teeth using a whitening gel aspiration tool.

Claims (1)

A method for changing the color of teeth, including taking an anamnesis, a dental examination, identifying the value of the KPU index, the level of hygiene, the cariogenicity of plaque, characterized in that a mouth expander is placed in the oral cavity, containing a rounded inner frame, an outer part to protect the lips, an inner part to protect buccal mucosa and a tongue retainer in the form of a curving strap connected to the inner part to protect the buccal mucosa and passing through the retromolar region along the lateral surfaces of the tongue, and in the region of the tip of the tongue the strap has an extension, while the inner frame, the outer part to protect the lips and the inner part to protect the buccal mucosa of the mouth expander is made of nitrile, and the tongue retainer is made of plastic, then the teeth are covered with a fluoroplastic sealing material, after which the composition is applied to the surface of the marginal gum and the area of the interdental papillae by means of directed aerosol spraying with several pulses, with the following traveling ratio of components, wt. %: sodium ascorbate - 11; polyvinylpyrrolidone - 15; distilled water-73.8; food flavorings - 0.2, allow the composition to dry until a film is formed, and then cover the film with a liquid rubber dam, apply a whitening gel and perform a whitening procedure, then remove highly concentrated substances from the surface of the teeth using a whitening gel aspiration tool, which contains the working part in the form a hollow tube consisting of a part of a larger diameter and a bent part of a smaller diameter, wherein the bent part of a smaller diameter is made for mounting a removable disposable hollow nozzle made of elastic material, on the upper part of which an atraumatic sponge with a hole is attached.

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