RU2801671C1 - Method of index assessment of the level of oral hygiene - Google Patents

Abstract

FIELD: medicine, dentistry.

SUBSTANCE: invention can be used to determine the level of oral hygiene in persons from the age of three. Plaque is detected by staining, while tablets are used as a staining agent, the said tablets are used to perform two-color staining of plaque depending on its age, the area of stained plaque on the central upper right and lower left incisors, upper right and lower left canines and four molars is estimated. The absence of staining is regarded as 0 points, staining of plaque up to 1/3 of the tooth surface is regarded as 1 point, staining of plaque up to 2/3 of the tooth surface is regarded as 2 points, staining of plaque more than 2/3 of the tooth surface is regarded as 3 points, when the colour of plaque is considered old, the resulting score is multiplied by the factor "2". The value of the hygiene index corresponds to the result of dividing the sum of points in the area of all examined teeth by the number of examined teeth. The resulting index value of 0 corresponds to the ideal level of oral hygiene, the value of 0.1–0.5 corresponds to good level of oral hygiene, the value of 0.6–1 corresponds to satisfactory level of oral hygiene, the value of 1.1–1.5 corresponds to unsatisfactory level of oral hygiene and the value of 1.6–6.0 corresponds to pathological level of oral hygiene.

EFFECT: invention allows to optimize the determination of the level of oral hygiene by using hypoallergenic non-toxic tablets as a dye; can be used in patients with deciduous, removable or permanent dentition.

1 cl, 2 ex

Description

The invention relates to medicine, namely to dentistry, and can be used to determine the level of oral hygiene in persons from the age of three.

In dental science and practice, there are a number of ways to assess the amount of dental plaque and the level of oral hygiene.

Known index for assessing the thickness of plaque according to Silnes-Low. The determination of this index does not require staining. When determining the Silnes-Low index, the thickness of dental plaque is estimated using a probe, examining four surfaces of the tooth (proximal, vestibular and oral) [1].

The method for assessing the amount of dental plaque according to the Silnes-Low index has a number of disadvantages. The use of this index is difficult in preschool children in milk bite (3-6 years), since it is not quite convenient and safe to use a sharp probe in the gingival region in this age category. In addition, the examination of the teeth with a probe from all four sides is a rather long and laborious process, which significantly delays the examination of children who find it difficult to sit for a long time during the diagnostic procedure. This method of assessment is not clear enough and, therefore, does not carry a motivating component for the patient, since in case of detection of plaque on the teeth by a dentist, it is difficult for a child and parents to visualize the identified dental deposits.

There is also known a method for assessing oral hygiene by counting the amount of plaque and tartar - according to Green-Vermillion. To determine this index, the vestibular surfaces of the 16th, 11th, 26th, and 31st teeth and the lingual surfaces of the 46th and 36th teeth are stained with an iodine-containing solution (for example, Schiller-Pisarev) [2].

The Green-Vermillion index also has disadvantages. The use of this index is limited only to permanent teeth, which makes it impossible to use it in children in milk bite. In addition, the main component of iodine-containing dyes that are used in this method of assessing oral hygiene - iodine - may develop drug allergies, which may be due to an overdose of drugs containing iodine, some chronic diseases or individual intolerance to iodine.

Another hygienic index of Fedorov-Volodkina is known. This index is used to assess the hygienic condition of the oral cavity in children under 5-6 years of age. To determine this index, the vestibular surfaces of the six frontal lower teeth are stained with special solutions (Schiller-Pisarev, fuchsin, erythrosine) [2].

The main disadvantage of the Fedorov-Volodkina index is that the plaque area is estimated only on the frontal group of teeth. It is known that children and adolescents clean their front teeth best, not paying enough attention to the side teeth. Thus, the teeth that children clean the worst are excluded from the survey, namely, these teeth are most often affected by caries in children. This aspect makes this index insufficiently objective. In addition, for example, erythrosin, which can be used when conducting this index, has a high health hazard, is a carcinogen and is prohibited in some countries [3].

The disadvantages of these methods for assessing the amount of plaque and the level of hygiene are the inconvenience or impossibility of using some indices in children in the milk bite, the lack of objectivity and clarity of other indices. A significant disadvantage is the insecurity and toxicity of some dyes that are used in the determination of a number of indices.

A known method of index assessment of the level of oral hygiene in young people, taken as a prototype [4]. The prototype method provides for accounting for the number of poorly cleaned teeth. When implementing this method, the entire dentition is examined. Determine the presence of plaque and (or) tartar on all teeth of the upper and lower jaws. Examine the vestibular, oral, medial, distal and occlusal surfaces of the molars and premolars and the vestibular, oral, medial and distal surfaces of the incisors and canines. The study can be carried out both with the help of a dental probe and with the help of dyes. The presence of plaque on any surface of the tooth is taken into account as one point. During the examination, the teeth, on which there are dental deposits, are counted. For the convenience of registration and further training in oral hygiene, you can use the dental formula in the outpatient chart of a dental patient, noting the presence of dental deposits with a dot above the tooth. The index value is equal to the number of points.

Evaluation criteria for the prototype method:

0 - good level of oral hygiene (consultation of a hygienist is not required);

1-6 - a satisfactory level of oral hygiene (correction of the method of brushing teeth);

7-12 - unsatisfactory level of oral hygiene (training in oral hygiene with the selection of means and items of oral hygiene, monitoring the level of hygiene);

13 or more - a critical level of oral hygiene (training in oral hygiene, selection of oral hygiene products and items, monitoring the level of hygiene, the use of therapeutic and prophylactic agents that affect the hard tissues of the tooth and periodontal tissues).

The disadvantages of the prototype method are:

- the limitation of the method by the possibility of using it in young people, as well as in older people, provided that the dentition is preserved, while in the description of the method there are no clear age criteria;

- the limited application of the method by such a criterion as "safety of the dentition", while in the description of the method there is no specification of this concept, there are no clear criteria for the number of teeth under which this method can be applied;

- long-term time spent on the examination of all surfaces (vestibular, oral, medial, distal and occlusal) of all teeth, which makes it impossible to use the method in children in milk occlusion and difficult in children in mixed dentition;

- the absence in the methodology of carrying out clear recommendations on the method of detecting plaque using a dental probe or dyes;

- the inability to use in childhood (in the period from 3 to 7 years), in the case of assessing the presence of plaque using a dental probe, due to the difficulties of a long-term examination with a sharp instrument of all surfaces of all teeth due to the restlessness of patients in this age group;

- lack of visibility and the possibility of visually demonstrating to patients the presence of dental plaque, in the case of assessing the presence of plaque using a dental probe;

- the absence of instructions in the method on the possibility of using a specific dye that is safe for use, including in children and in people with chronic diseases;

- lack of consideration in the method of pathogenetically and clinically significant in the development of dental pathology criterion of limitation of plaque formation;

- brevity and vagueness of the treatment and preventive program corresponding to a certain level of oral hygiene;

- lack of a description of the program of therapeutic and preventive measures in a situation where the patient is a child.

The invention is based on the goal of improving the method for assessing the level of oral hygiene, including the detection of plaque by staining, the examination of all surfaces of the teeth for the presence of plaque, the calculation of the index and its evaluation, by using tablets as a staining agent, which carry out two-color staining of plaque depending on on its prescription, assessment of the area of stained plaque on the central upper right and lower left incisors, upper right and lower left canines and four molars, while the absence of staining is regarded as 0 points, staining of plaque up to 1/3 of the tooth surface - as 1 point, up to 2/3 - as 2 points, staining more than 2/3 of the tooth surface - as 3 points, when plaque is stained in the color of an old one, the score obtained is multiplied by the coefficient "2", the value of the hygiene index corresponds to the result of dividing the sum of points in the area of all examined teeth on the number of examined teeth (8), the resulting index value of 0 corresponds to the ideal level of hygiene, 0.1-0.5 - good, 0.6-1 - satisfactory, 1.1-1.5 - unsatisfactory and 1.6-6 ,0 - pathological level of oral hygiene, additionally a certain level of hygiene corresponds to a list of therapeutic and preventive measures.

The proposed method is carried out as follows: the patient, with the participation of a dentist, places one tablet (for children - 1/2 tablet) to indicate plaque, which carries out its two-color staining, for example "Paro Plak 2" ("Miradent Mira-2-Ton" or others) on the tongue, chews it, distributes the particles of the tablet in the oral cavity with the tongue and spits.

Paro Plak 2 plaque-indicating tablets and the like consist of a combination of food colorings that react with the organic components of the plaque, thereby staining it. Plaque with a statute of limitations of 0-3 days when using Paro Plak 2 tablets turns red, plaque that is more than 3 days old turns blue. In the case of using other means for two-color indication of dental plaque, the color should be clarified in the instructions for the drug.

It is reliably known that the prescription of plaque formation has an important pathogenetic and clinical significance in the development of dental pathology (caries, periodontal disease). The formation of dental plaque is regulated, including the degree of cleaning of the oral cavity - the worse the hygiene, the faster the plaque matures [2]. As the plaque grows, its microbial flora changes from the predominance of cocci to rod and filamentous microorganisms. Fresh (first 2 days) plaque consists mainly of cocci (S. mutans and S. Sangues). The composition of the flora on the 4th day (gram + and gram-cocci, filaments) causes gingivitis. The composition of the plaque microflora on the 9th day is identical to that in periodontitis [5]. According to modern concepts, the microbial composition of plaque has a decisive influence on the type of periodontal tissue diseases [6]. According to this, the degree and type of inflammation of periodontal tissues depend not so much on the amount of dental deposits, but on the specificity of their microbial flora. So, for example, in certain forms of periodontitis (rapidly progressive forms), gram-negative rods and cocci (anaerobic microorganisms with aggressive invasive and destructive properties) predominate [2]. Therefore, it is important to establish not only the quantity, but also the "prescription" of plaque formation - the degree of maturity of dental plaque, which reflects its microbial composition. That is why it is advisable to use dyes that differentiate between fresh and old dental plaque, which has a different pathogenetic significance in the development of dental pathology.

After staining with a tablet, the area and color (reflecting prescription) of plaque on the tooth surface (vestibular, oral, approximal), which is most stained, are evaluated on the following eight teeth of different groups (incisors, canines, molars):

- incisors - central upper right and lower left incisors (51, 71 teeth - in milk occlusion; 11, 31 teeth - in permanent occlusion);

- fangs - upper right canine (53 tooth - in milk bite; 13 tooth - in permanent) and lower left canine (73 or 33 tooth);

- molars - the second temporary molars on the right and left on the upper and lower jaws (55, 65, 75, 85 teeth) or the first permanent molars on the right and left on the upper and lower jaws - 16, 26, 36, 46 teeth.

In the absence of a tooth, for example, removed due to complicated caries, it is suggested to examine the adjacent tooth of the same group. That is, in the absence of the second milk molar, the area and color of plaque on the surface of the first milk molar are estimated, in the absence of the first incisor, the plaque on the second incisor is evaluated, in the absence of a canine, also on the second incisor.

The following are proposed as criteria for assessing the index:

0 points are assigned if the tooth is not stained;

1 point - stained up to 1/3 (inclusive) of the tooth surface;

2 points - the tooth is stained up to 2/3 of the surface (inclusive);

3 points - the tooth stained more than 2/3 of the surface.

Such evaluation criteria are assigned if the plaque has turned into a color corresponding to fresh plaque (in a situation where Paro Plak 2 tablets are used - red). If the plaque turns into a color corresponding to the staining of an old plaque - for more than 3 days (in the case of the use of Paro Plak 2 tablets - in blue), the score obtained (1, 2, 3) is multiplied by the coefficient - "2".

Further, to calculate the index, the scores obtained in the area of all examined teeth are summed up and divided by the number of examined teeth:

It is proposed to interpret the indicator obtained during the calculation of the index as follows:

- 0 points - the ideal level of hygiene. All surfaces of all teeth are completely free from plaque. A consultation with a dentist regarding oral hygiene is not required;

- 0.1-0.5 points - a good level of hygiene. The patient completely cleans the frontal group of teeth, i.e. all incisors and canines of the upper and lower jaws do not have plaque, and only the lateral teeth (molars) have a small amount of fresh plaque (up to 1/3 of the surface). The revealed fresh raid was formed during the last three days. Perhaps the violation of the technique of brushing your teeth is temporary. Minor correction of the method of brushing teeth is required. Fresh plaque can be removed by the patient himself in the process of careful personal hygiene;

- 0.6-1.0 points - a satisfactory level of hygiene. Most of the examined 8 teeth are covered with fresh plaque up to 1/3 of the surface. Requires training in individual oral hygiene, selection of means and items for hygiene, controlled brushing of teeth;

- 1.1-1.5 points - unsatisfactory level of hygiene. All teeth are covered with plaque up to 1/3 of the surface, and some teeth may have old plaque. Professional oral hygiene is required, training in individual oral hygiene, the selection of means and items for hygiene, it is necessary to carry out medically controlled cleaning of the teeth. If the patient is a child, strict parental supervision of the child's oral hygiene is also necessary;

- 1.6-6.0 points - pathological level of oral hygiene. This level is clinically significant. Almost all examined teeth are more than 1/3 covered with plaque, many or all teeth are covered with old plaque. Violation of oral hygiene is systematic, regular. This is confirmed by the volume of old plaque. Often, under a thick layer of dental plaque, the patient has foci of acute initial caries, sometimes with softening or a defect in the center. Patients with this level of hygiene often have a high level of caries intensity. Usually there are also periodontal diseases (for example, chronic catarrhal gingivitis), caused by the influence of a large amount of dental deposits, which have proven pathogenetic significance in the development of this pathology. As a rule, the patient has a formed dental pathology: caries and / or its complications, periodontal disease. A complex of therapeutic and preventive measures is required. Professional oral hygiene is required, training in individual oral hygiene, selection of oral hygiene products and items, the use of therapeutic and prophylactic agents that affect the hard tissues of the tooth (for example, remineralizing gels) and periodontal tissues (antiseptic, anti-inflammatory drugs) is indicated, it is necessary to implement supervised brushing of the teeth and, if the patient is a child, then strict parental supervision is needed for the implementation of oral hygiene. Probably, the patient needs oral sanitation, which consists in the treatment of the existing pathology: caries and / or its complications, periodontal diseases.

Specific examples of the implementation of the method.

Example 1. Patient A., 5 years old, went with her parents to see a dentist. Objectively in the oral cavity: all milk teeth are present.

When examining a child, a filling was found in the 75th tooth. Carious cavity of medium depth in 84 tooth. The child's teeth are cleaned of plaque quite well. After applying ½ tablet "Paro Plak 2" the teeth were stained as follows: the vestibular and oral surfaces of 55, 65, 75, 85, as well as the vestibular surface of 73 teeth, were stained in the color of fresh plaque up to 1/3 of the surface; 51, 71, 53 teeth were not stained.

Hygiene index calculation:

Obtained in the process of calculation in patient A. (5 years) the value of the index of hygiene - 0.625 points corresponds to a satisfactory level of hygiene. Most of the examined 8 teeth are covered with fresh plaque up to 1/3 of the surface. The child needs training in individual oral hygiene, the selection of means and hygiene items in accordance with age, controlled brushing of teeth and attentive attitude on the part of parents to the implementation of oral hygiene by the child.

Example 2. Patient M., aged 17, applied for an appointment with a dentist. Objectively in the oral cavity: all teeth are present except for the third permanent molars on the upper and lower jaws on the right and left.

Examination of the patient revealed: acute deep caries 46; acute superficial caries 14, 34, 17, 27; , 36 teeth, generalized chronic catarrhal gingivitis of moderate severity.

After using the tablet "Paro Plak 2", the vestibular surfaces of 11, 31, 13 teeth from the vestibular side were stained by 1/3, the vestibular surfaces of 16, 26 and the oral surfaces of 23, 26, 36 were stained to 2/3. At the same time, up to 1/3 of the surfaces of all examined teeth turned into a color corresponding to an old plaque.

Hygiene index calculation:

Thus, this patient M. by the proposed method was diagnosed with a pathological level of hygiene - 3.25 points. He needs professional hygiene and training in individual oral hygiene, the selection of tools and items for oral hygiene. The patient is shown the use of therapeutic and prophylactic agents that affect the hard tissues of the tooth (for example, remineralizing gels) and periodontal tissues (antiseptic, anti-inflammatory drugs), it is necessary to carry out controlled brushing of the teeth. Comparing the proposed evaluation criteria with the patient's diagnoses, we can conclude that the indicator reflects the situation in the oral cavity and corresponds to the clinical picture. The patient has a serious problem with oral hygiene. It is likely that there is an incorrect brushing technique that has led to the deposition of a large amount of plaque in typical places. Tooth plaque in these areas is old.

An example of assessing the level of oral hygiene according to the prototype method.

For a comparative analysis of the claimed and known methods for assessing oral hygiene (taken as a prototype), oral hygiene was assessed in this patient M. in accordance with the prototype method. When examining the entire dentition in patient M., the presence of plaque on all 28 teeth was noted. In accordance with the method of index assessment of the level of oral hygiene in young people [4], using the evaluation criteria for this patient, we get 28 points, which corresponds to a critical level of hygiene. According to the recommendations of the prototype, the patient needs: training in oral hygiene, selection of tools and items for oral hygiene, monitoring the level of hygiene, the use of therapeutic and prophylactic agents that affect the hard tissues of the tooth and periodontal tissues.

The proposed method for indexing the level of oral hygiene has a number of advantages.

The tablets used as a means for staining dental plaque (Paro Plak 2, Miradent Mira-2-Ton, etc.) are hypoallergenic, non-toxic and carry out two-color staining of plaque, depending on the age of its formation.

The method is universal in age. It can be used in patients from the age of three. This age limit is due to the information provided in the instructions on the possibility of using tablets for plaque staining from the age of three. The method can be used in patients with milk, removable or permanent dentition.

The method can be used in persons who have lost part of their teeth, provided that at least 1 tooth belonging to a certain group (incisors / canines, molars) is preserved on the upper and lower jaws on each side. The methodology stipulates which tooth color should be taken into account when calculating, in the absence of the one indicated initially in the formula, that is, the situation of partial dentition defects is taken into account both in children and in adult patients.

The evaluation criteria given in the method provide for an expanded specific list of therapeutic and preventive measures that the patient needs.

The proposed evaluation criteria are of practical importance for clinical dentistry, as they describe the clinical situation in the oral cavity and establish an etiopathogenetic relationship between the amount of plaque, the duration of its formation, the level of hygiene and the presence of dental diseases.

The method has a clear and motivating component for the patient, since the bright two-color staining of the plaque allows you to clearly demonstrate to the patient the parts of the teeth that are not sufficiently cleaned by him, so that he takes these errors into account in the future when implementing hygiene. Also, bright multi-colored staining makes it possible to interest the patient-child in carrying out a diagnostic procedure.

Thus, the proposed invention optimizes the determination of the level of oral hygiene by using tablets as a dye for detecting plaque, which carry out two-color staining of plaque depending on its age, for example "Paro Plak 2", as well as introducing a new calculation formula and new evaluation criteria .

Information sources:

1. Khomenko L.A. Therapeutic dentistry of children's age. - Kyiv: Book Plus, 2013. - 816 p.

2. Borodovitsina S.I. Prevention of dental diseases: textbook / S.I. Borodovitsina, N.A. Saveliev, E.S. Tabolina; FGBOU VO RyazGMU of the Ministry of Health of Russia. - Ryazan: OTSiOP, 2019. - 264 p.

3. Potential toxicity of food azo dyes recognized as safe in Ukraine // Medical aspect of human health. - No. 4 (6). - 2012. - S.34-38.

4. RF patent No. RU 2307593 C1, IPC A61V 10/00 (2006.01); publ.: 10.10.2007, Bull. No. 28.

5. Modern methods in the complex treatment of inflammatory periodontal diseases: monograph / O.A. Gulyaeva, R.T. Bulyakov, L.P. Gerasimova, T.S. Chemikosova. - Ufa: Publishing house "UralPolygraphSnab", 2016. - 190 p.

6. Lehmann K., Helvig E. Fundamentals of therapeutic and orthopedic dentistry. Ed. S.I. Abakarova, V.F. Makeev. Per. with him. - Lvov: GalDent, 1999. - 262 p.

Claims (1)

A method for index assessment of the level of oral hygiene, including the detection of plaque by staining, examination of all surfaces of the teeth for the presence of plaque, calculation of the index and its assessment, characterized in that tablets are used as a staining agent, performing two-color staining of plaque, depending on its duration , evaluate the area of stained plaque on the central upper right and lower left incisors, upper right and lower left canines and four molars, while the absence of staining is regarded as 0 points, staining of plaque up to 1/3 of the tooth surface - as 1 point, up to 2/3 - as 2 points, staining more than 2/3 of the tooth surface - as 3 points, when plaque is stained in the color of an old one, the score obtained is multiplied by the coefficient "2", the value of the hygiene index corresponds to the result of dividing the sum of points in the area of all examined teeth by the number of examined teeth, the obtained index value of 0 corresponds to the ideal level of hygiene, 0.1-0.5 - good, 0.6-1 - satisfactory, 1.1-1.5 - unsatisfactory and 1.6-6.0 - pathological level of hygiene oral cavity.