Methodology for determining the increase in caries intensity. A method for determining the intensity of caries of permanent teeth in children during the period of mixed dentition. How to identify the distribution zone
1. Prevalence of dental caries- this is the ratio of the number of people with at least one of the signs of caries (carious, filled or extracted teeth) to the total number of those examined, expressed as a percentage (%).
WHO assessment criteria for the level of caries prevalence for 12-year-old children: low - 0-30%; average – 31-80%; high – 81-100%.
Intensity of dental caries
To assess the intensity of dental caries, we determine the index KPU - this is the sum of teeth affected by untreated caries (component “K”), filled teeth (“P”) and extracted teeth (“U”) per examined child.
Caries intensity index - CPI: 
, Where
K - the sum of teeth affected by untreated caries,
P - filled teeth;
Y - extracted teeth.
Criteria for assessing the CP index in children 12 years old (WHO):
Very low – 0.00-0.50
Low – 0.51- 1.50
Average – 1.51-3.00
High – 3.01- 6.50
Very high – 6.51-10.00
Epidemiological studies indicate the accumulation and growth of pathological processes in the hard tissues of teeth, the development of the carious process, an increase in the number of periodontal diseases and dental anomalies, which is due to the lack of volume and quality of systematic work on sanitation of the oral cavity in children.
In children, the caries intensity indicator is assessed before the complete replacement of temporary teeth with permanent ones.
When surveying the population, the most informative age groups are 12.15 years and 35-44 years. The incidence of dental caries at the age of 12 years and the condition of the periodontium at 15 years of age make it possible to judge the effectiveness of preventive measures, and on the basis of the PCI index at the age of 35-44 years, the quality of dental care for the population can be assessed. Analysis of the results of examination of patients of different age groups shows that with age there is a tendency to increase caries of permanent teeth from 20-22% in 6-year-old children to 99% in people 65 years and older, in whom an average of 20-22 teeth were affected.
Information obtained from epidemiological dental surveys provides the basis for assessing the need for treatment, the number of personnel required at the regional level, and the cost of dental programs. The need for dental care is determined by the need to take measures to prevent and treat dental diseases, provide surgical, orthopedic, orthodontic and other types of care.
Indicators of population coverage with dental care
Indicators characterizing the level of provision of the population with dental care are calculated for a specific service area (city, district, etc.).
1. Indicator of population seeking dental care:
2. Indicator of accessibility of dental care:
3. Provision of the population with existing dental jobs per 10 thousand inhabitants:
4. Provision of population with dentists (dentists) per 10 thousand inhabitants:
5. Indicator of population provision with dental beds:
Thus, mastering the knowledge of the basics of organizing dental care and aspects of the scientific organization of work at the beginning of the 21st century will significantly contribute to the growth of the professional level of a dentist, which, along with the introduction of new methods of diagnosis, treatment and rehabilitation into clinical practice, will improve the quality of dental care. to the population.
5. CHECK QUESTIONS
1. What are the stages of dental care?
2. List the types of institutions providing dental care?
3. How is outpatient dental care organized?
4. Give a classification of dental clinics.
6. What are the main tasks and functions of a dental clinic?
7. What are the staffing standards of the dental clinic: dentists; nursing staff; junior medical staff?
8. What is the structure of an independent dental clinic?
9. How is the work of the reception desk of a dental institution organized?
10. What are the main sections of the work of dentists?
11. How is emergency outpatient dental care organized?
12. How is medical examination of the population carried out by dental institutions?
13. List the contingents of those undergoing medical examination?
14. How is the effectiveness of dispensary observation of dental patients assessed?
15. What is the procedure for organizing the work of the orthopedic department?
16. What are the tasks and organization of the periodontal office?
17. What are the features of the organization of dental care in medical units (MSU)?
18. How is dental care for children organized?
20. What activities should a pediatric dentist perform in providing medical care to children?
21. How is the activity of the dental office organized in educational groups?
22. What activities should an orthodontist perform to provide medical care to children?
23. What activities should a dental surgeon perform in providing medical care to children?
24. What activities should a dental hygienist perform to provide medical care to children?
25. What are the features in organizing dental care for the rural population?
26. Describe the stages of providing dental care to the rural population.
27. What is the structure and features of the organization of work of republican (regional, regional) dental clinics?
28. List the activities related to the primary, secondary and tertiary levels of prevention of dental diseases?
29. List the main forms and methods of planned sanitation of the oral cavity.
30. Indicate the features of oral sanitation in organized teams?
31. Which child is considered sanitized?
32. What are the main accounting and reporting documents in the dental service?
33. Describe the main sections of the annual report of the dental service.
34. What are the main quality indicators of the dental service.
Dental caries(Fig. 2.1) remains a pressing problem in dentistry to this day. This disease occurs after teething. It is based on the process of demineralization and proteolysis of hard dental tissues, leading to the formation of a defect in the form of a cavity.
Rice. 2.1. Dental caries
2.1. CRITERIA FOR ASSESSMENT OF CARIOUS LESIONS
The criteria for assessing the condition of hard dental tissues in the population are the prevalence and intensity of caries in temporary and permanent teeth.
Prevalence of dental caries - this is the ratio of the number of persons with at least one of the signs of dental caries (carious, filled or extracted teeth) to the total number of those examined, expressed as a percentage.
WHO assessment criteria for the prevalence of dental caries in 12-year-old children.
Prevalence rate of dental caries in 12 year olds (WHO criteria): low 0-30%; average 31-80%; high 81-100%.
Intensity of dental caries - this is the sum of clinical signs of carious lesions (carious, filled and extracted teeth), calculated individually for one patient or group of examined people.
For rate intensity of caries of temporary teeth use indexes:
. kpu (z)- the sum of teeth affected by caries, filled and extracted in one examined child;
. kpu (p)- the sum of tooth surfaces affected by caries, filled and removed in one examined child.
Note. When determining the number of teeth or surfaces removed, only those that are removed prematurely, before the physiological resorption of the roots, are counted.
For rate caries intensity of permanent teeth use indexes:
. KPU (z)- the sum of teeth affected by caries, filled and removed due to complications of caries in one examined;
. KPU (p)- the sum of tooth surfaces affected by caries, filled and removed due to complications of caries in one examinee.
Note. If a tooth in the anterior group is removed, then 4 surfaces are taken into account when calculating the CPU index (p), if a tooth in the chewing group is removed, 5 surfaces are taken into account. When determining caries intensity indices, its initial form in the form of focal demineralization of the enamel is not taken into account.
For rate intensity of caries during the period of tooth change(from 6 to 12 years old) use indexes CPU And kp teeth and surfaces. The intensity of caries of temporary and permanent teeth and surfaces is calculated separately.
Intensity of caries in the group examined- this is the ratio of the sum of individual indicators of caries intensity indices of teeth or surfaces to the number of examined people.
Level of intensity of dental caries (according to the KPU index) in 12-year-old children and adults (WHO criteria):
2.2. PREVALENCE AND INTENSITY OF DENTAL CARIES AMONG THE RUSSIAN POPULATION
Currently, dental caries is one of the most common dental diseases among children and adults in the Russian Federation.
According to an epidemiological dental survey (2009) conducted among key age groups of the Russian population, prevalence of caries in primary teeth in 6-year-old children was 84%, average intensity of caries of primary teeth according to the index kpu (z) - 4.83, while the component “k” is equal to 2.9, “p” - 1.55, “y” - 0.38.
Average prevalence and intensity of caries in permanent teeth in the Russian population:
The data presented are the result of a national epidemiological dental examination of 55,391 people living in 47 regions of the Russian Federation. The survey was carried out in 2007-2008. using codes and criteria for assessing dental status proposed by WHO.
According to the results obtained, the incidence of caries in different areas is not the same. The most significant relationship was found between the intensity of caries of temporary and permanent teeth and the fluoride content in drinking water: when the fluoride concentration is more than 0.7 mg/l, it is lower and increases if the fluoride content is less than 0.7 mg/l. This dependence can be seen more clearly in the age groups of 6, 12 and 15 years. Among the adult population, this trend is less pronounced, which is probably due to the action of many cariogenic factors (Fig. 2.2, 2.3).
Rice. 2.2. Average intensity of caries in primary teeth in areas with different levels of fluoride in drinking water
Rice. 2.3. Average intensity of caries in permanent teeth in areas with different levels of fluoride in drinking water
The average rates of caries intensity in urban and rural populations did not differ significantly.
A low level of caries intensity according to WHO grading in 12-year-olds was registered in 27 regions, an average level in 19, and a high level in one region.
The level of intensity of dental caries in the adult population in most regions was assessed according to WHO grading as high.
An analysis of the results of the second national epidemiological dental survey revealed a tendency towards a decrease in the average intensity of caries in permanent teeth in the children's population compared to data from 10 years ago (1999), but in adults and the elderly they still remain high.
2.3. NEED FOR DENTAL TREATMENT
POPULATION OF RUSSIA
The results of a population survey made it possible to determine the need for various types of treatment of hard dental tissues. Thus, 52% of six-year-old children require filling of one surface, and 45% - two or more surfaces of temporary teeth. 13 and 22%, respectively, require endodontic treatment and tooth extraction.
The need for treatment of permanent teeth in this age group was reduced mainly to the need for preventive measures, in particular sealing the fissures of the first permanent molars (52%), prescribing remineralizing therapy (51%), as well as filling one (13%) and two (5% ) surfaces of permanent teeth.
In the group of 12-year-olds, the need for dental fillings sharply increases (46% - one, 21% - two surfaces or more), endodontic treatment and removal of permanent teeth (8 and 10%, respectively), and the need for preventive measures (sealing the fissures of second permanent molars) remains high (48%).
In 15-year-old adolescents, the need for the listed types of dental care increases, and the need for orthopedic treatment is determined - the production of artificial crowns.
Among the adult population, there remains a high need for fillings, prosthetics (55%) and extraction (23%) of teeth, and elderly people mainly needed prosthetics (63%) and tooth extraction (35%).
2.4. RISK FACTORS FOR DENTAL CARIES
Local factors:
Presence of dental plaque (poor hygienic oral care);
High content of easily fermentable carbohydrates in the diet;
Changes in the quantitative and qualitative composition of oral fluid;
Low enamel caries resistance;
Incomplete mineralization of the fissure enamel of permanent teeth during their eruption;
The presence of factors contributing to the retention of dental plaque (anomalies in the position of teeth, fixed orthodontic and orthopedic structures, overhanging edges of fillings, etc.).
General factors:
Low fluoride content in drinking water;
Unbalanced diet, nutritional deficiency of minerals (primarily calcium and phosphates), vitamins;
Somatic diseases (chronic pathology of the digestive tract, endocrine system), metabolic disorders, hypovitaminosis; congenital anomalies of the maxillofacial region;
Extreme effects on the body, stress;
Unfavorable environmental conditions. The following groups are at greater risk of caries:
Pregnant women and young children (from 0 to 3 years);
Children during the eruption of permanent teeth;
Persons who have difficulties with hygienic oral care (those with fixed orthodontic and orthopedic structures, abnormal tooth position, etc.);
Workers in hazardous industries (chemical, confectionery, etc.).
2.4.1. METHODS FOR DETERMINING THE RISK OF DENTAL CARIES
ASSESSMENT OF HYGIENIC CONDITION
ORAL CAVITIES
Plaque detected visually when examining the oral cavity using a dental probe and using indicator means:
1) tablets, solutions containing erythrosine, fuchsin (tablets "Espo-Plak"("Paro") "RedCote" ("Butler"), solution for plaque detection (“PresiDENT”) and etc.;
2) iodine-containing solutions (Lugol, Schiller-Pisarev solutions) (Fig. 2.4);
3) preparations containing fluorescein for visualizing dental plaque in ultraviolet rays.
Rice. 2.4. Dental plaque stained with Schiller-Pisarev solution
INDICES FOR DETERMINING THE HYGIENIC CONDITION OF THE ORAL CAVITY
1. Dental plaque assessment index in young children(from the moment the first teeth erupt until 3 years) (Kuzmina E.M., 2000).
To assess this index, the presence of plaque on all teeth in the oral cavity is determined visually or using a dental probe.
Codes and evaluation criteria:
0 - there is no plaque;
1 - presence of dental plaque. Index calculation:
where IG is the hygiene index for young children. Interpretation of results
2. Fedorov-Volodkina Index(1971).
Recommended for assessing the hygienic condition of the oral cavity in children under 5-6 years of age. To assess the index, the vestibular surface of six frontal teeth of the lower jaw is stained: 83, 82, 81, 71, 72, 73.
Codes and evaluation criteria:
1 - no staining;
2 - staining 1/4 of the surface of the tooth crown;
3 - staining 1/2 of the surface of the tooth crown;
4 - staining 3/4 of the surface of the tooth crown;
5 - staining the entire surface of the tooth crown. Index calculation
where IG is the Fedorov-Volodkina hygiene index.
Interpretation of results
3. Dental Hygiene Performance Index
mouth RNR(Podshadley A.G., Haley P., 1968). Index teeth:
16, 11, 26, 31 - vestibular surface;
36, 46 - oral surface.
If there is no index tooth, the adjacent tooth within the group of the same name is stained.
The examined tooth surface is divided into 5 sections:
1 - medial; 2 - distal;
3- mid-occlusal;
4- central; 5 - midcervical.
Codes and evaluation criteria:
0 - no staining;
1 - coloring of any intensity. Index calculation:
where RHP is the oral hygiene effectiveness index.
Interpretation of results
4. Oral hygiene index IGR-U
(OHI-S - Oral Hygiene Index-Simplified; Greene J.S., Vermillion J.K., 1964).
Determines the presence of dental plaque (by staining the surfaces of index teeth with indicator solutions) and tartar (by probing).
Index teeth:
16, 11, 26, 31 - vestibular surface; 36, 46 - oral surface. Codes and criteria for assessing dental plaque:0 - no dental plaque was detected;
1 - soft plaque covering no more than 1/3 of the tooth surface, or the presence of any amount of pigmented plaque;
2 - soft plaque covering more than 1/3, but less than 2/3 of the tooth surface;
3 - soft plaque covering more than 2/3 of the tooth surface.
Codes and criteria for assessing dental calculus:
0 - no tartar was detected;
1 - supragingival tartar, covering no more than 1/3 of the tooth surface;
2 - supragingival calculus, covering more than 1/3, but less than 2/3 of the tooth surface, or the presence of individual deposits of subgingival calculus in the cervical area of the tooth;
3 - supragingival calculus covering more than 2/3 of the tooth surface, or the presence of significant deposits of subgingival calculus around the cervical area of the tooth.
Index calculation:
where IGR-U is a simplified oral hygiene index.
Interpretation of results
5. Index of plaque on proximal surfaces of teeth API(Lange D.E., Plagmann H.,
1977).
Using staining, the presence of plaque on the contact surfaces of the teeth and in the interdental spaces is determined:
II and IV quadrants - from the vestibular surface; Quadrants I and III - from the oral surface.
Criteria for evaluation:
0 - there is no plaque;
1 - presence of plaque in the interdental space. Index calculation:
where API is the index of plaque on the proximal surfaces of the teeth.
Interpretation of results
2.5. ASSESSMENT OF THE PROPERTIES OF ORAL FLUID AND DENTAL PLAQUE
Determination of saliva secretion rate.
It is recommended to collect saliva 1.52 hours after eating. The patient is warned in advance that during this time he should refrain from eating chewing gum, sweets, smoking, drinking heavily, and rinsing his mouth.
For determining rate of unstimulated salivation The patient, at rest, spits the saliva in the oral cavity into a test tube with a funnel for 5 minutes. Release rate stimulated saliva determined by collecting saliva released when chewing a paraffin ball into a test tube.
In both cases, the volume of collected saliva is recorded and the rate of salivation (ml/min) is determined.
Norm:
The rate of unstimulated salivation is 0.2-0.5 ml/min;
With mechanical stimulation - 1-3 ml/min.
Determination of saliva viscosity. The test is performed using an Oswald viscometer on an empty stomach or 3 hours after a meal. Measurements are carried out three times.
Norm - 4.16 units; an increase in saliva viscosity by 2 times or more indicates low enamel caries resistance.
An express method for diagnosing the buffer properties of saliva using the “CRT buffer” system.
The system includes a test indicator strip and a control gradation scale. A drop of stimulated saliva is applied with a sterile pipette to the pad of the test strip. After 5 minutes, evaluate the result by comparing the color of the strip with the color table (Fig. 2.5).
Indicator strip color:
. blue (pH >6.0)- high (normal) buffer capacity;
. green (pH=4.5-5.5)- average (below normal) buffer capacity;
. yellow (pH<4,0) - low buffer capacity of saliva.
Note. If the coloring turns out to be heterogeneous, interpret the result towards a lower value.
Rice. 2.5. Determination of the buffer capacity of saliva using the CRT buffer system
pH-metry of oral fluid and dental plaque. Accurate pH determination oral fluid and dental plaque is carried out using a pH-selective electrode. Mixed saliva is collected on an empty stomach in the morning in an amount of 20 ml. After
After three studies of the same sample, the average is calculated. The pH of the oral fluid can be measured directly in the patient’s oral cavity by placing the electrode in the sublingual area (the norm at rest is 6,8-7,4; at pH less than 6.0, saliva promotes the process of demineralization of enamel).
To determine the pH of plaque, the tooth is isolated from saliva using cotton swabs and air dried. The electrode is placed sequentially on the vestibular and oral surfaces of the teeth in the cervical area and the readings of the device are recorded (normal at rest 6,5-6,7, the critical pH value of dental plaque, at which the process of enamel demineralization begins, - 5,5-5,7).
Express method for determining the number of cariogenic bacteria (S. mutans And Lactobacilli) using the CRT bacteria system. For the study, stimulated saliva or dental plaque samples are collected and inoculated onto an agar-coated plate (which is a selective nutrient medium for S. mutans or Lactobacilli), which is incubated for 48 hours at 37 °C.
The density of colonies grown on agar surfaces is compared with the density value in the reference table. Colony Density S. mutans And Lactobacillimore than 10 5 CFU/ml indicates a high risk of dental caries, less than 10 5 CFU/ml- about low (Fig. 2.6).
Note. Before the examination, patients should not use antibacterial rinses; professional oral hygiene is not recommended.
Despite obvious successes in the prevention of dental caries, this disease still represents a serious problem for public health in most countries of the world, especially due to the steady increase in the cost of restorative treatment and new evidence of the relationship between caries complications and a number of general somatic diseases.
Rice. 2.6. Variants of Lactobacilli colony density determined using the CRT bacteria system
For the convenience of designating teeth in the dental arch and recording the results of dental examinations, various schemes are used.
For a long time in our country they used the Zsigmond-Palmer scheme, proposed in 1876. According to this scheme, the teeth in each quadrant are numbered from 1 to 8, i.e. from central incisors to wisdom teeth. Arabic numerals are used to designate permanent teeth, and Roman numerals are used for milk teeth. Whether a tooth belongs to the upper or lower jaw and the side of location is determined by the direction of intersection of the horizontal and vertical lines separating the quadrants (Fig. 2.7).
Currently, it is advisable to use digital systems, which are more convenient. The International Dental Federation (FDI) system is widely used throughout the world. This system is recommended by the World Health Organization (WHO) and the International Organization for Standardization (ISO). In this system, each permanent tooth in each quadrant is designated by a number from 1 to 8, as in the Zsigmond-Palmer system. Temporary teeth are also designated by numbers from 1 to 5. Quadrants are numbered clockwise.
ke, starting from the upper right quadrant. In the permanent bite, the quadrants are numbered from 1 to 4, in the primary dentition - from 5 to 8. Thus, each tooth is designated by two numbers: the first number is the quadrant number, the second is the number of the tooth in the quadrant. So, for example, the second left premolar of the upper jaw will be designated as tooth 24, and the left upper lateral primary incisor - 62 (Fig. 2.8).
2.6. THEORIES OF DENTAL CARIES
Rice. 2.7. Zsigmond-Palmer system
Rice. 2.8. FDI system
temperature 37 °C for 4-6 weeks. Under the influence of lactic acid fermentation products, demineralization of the enamel occurred, to some extent similar to changes in it during caries.
In 1928 D.A. Entin developed a physicochemical theory of caries, according to which the hard tissues of the tooth are a semi-permeable membrane at the boundary of two environments - oral fluid (saliva) and dental pulp (blood). The scientist believed that the predominance of osmotic currents in the centripetal direction causes pathological changes in the hard tissues of teeth, since the nutrition of the enamel from the pulp is disrupted and the effect of external agents, in particular microorganisms, on the enamel is increased, which leads to caries.
Other theories are known: the neurotrophic theory of D.A. Entin (1928), biological theory of caries I.G. Lukomsky (1948), exchange theory of A.E. Sharpenak (1949), working concept of the pathogenesis of dental caries by A.I. Rybakova (1971).
It has been established that dental caries is an infectious process that manifests itself after teething, during which demineralization and proteolysis of hard tooth tissues occur with the subsequent formation of a defect in the form of a cavity.
The main reason for demineralization of enamel and the formation of a carious lesion is organic
ical acids. Lactic acid plays the main role. Acids are formed during the fermentation of carbohydrates supplied with food by plaque microorganisms.
Excessive consumption of carbohydrates and insufficient hygienic care of the oral cavity lead to the accumulation and multiplication of cariogenic microorganisms on the surface of the tooth and the formation of dental plaque. Continued consumption of carbohydrates contributes to a local change in pH in the acidic direction. In clinical experimental studies, this is convincingly demonstrated by the Stefan curve, which reflects the dynamics of changes in the pH of dental plaque when monosaccharides, such as glucose, enter it (Fig. 2.9).
Initially, there is a sharp decrease in the pH of dental plaque - to 4.5, and then the value slowly recovers to normal over 30-40 minutes. If the pH decrease is constantly repeated in the future, then as a result of demineralization, subsurface lesions (carious spots) are formed, and subsequently carious cavities. The condition of the structure of the hard tissues of the tooth is of significant importance.
Resistance (caries resistance) of teeth to caries is formed when the chemical composition, structure, and permeability of enamel and other tooth tissues are complete. The amount of oral fluid (saliva) and its mineralizing potential are of no small importance. A carbohydrate-balanced diet, good oral hygiene and optimal levels of fluoride in drinking water are also components of dental caries resistance.
In case of disturbances that arise during the development of dental tissues, maturation of enamel when the parameters of the oral fluid change, insufficient
Rice. 2.9. Stefan curve
2.7. ROLE OF PLAQUE, SALIVA AND ENAMEL PERMEABILITY IN CARIES
It is known that a number of surface formations are detected on the enamel. The cuticle, which is a reduced epithelium of the enamel organ, disappears soon after tooth eruption as a result of abrasion during chewing and partially remains only in the subsurface layer of the enamel.
The surface of a functioning tooth is subsequently covered with pellicle (acquired cuticle), which is a protein-carbohydrate complex formed under the influence of saliva. The pellicle is firmly connected to the surface of the enamel due to penetration into its surface layer.
The next surface formation is that formed on the pellicle plaque, representing soft deposits on the surface of the enamel. To designate this substance, terms such as “dental plaque” and “biofilm” are used.
Most often, dental plaque acts as a powerful cariogenic factor, which necessitates its careful and regular removal.
An important stage in the formation of dental plaque is the incorporation of various types of microorganisms into its matrix. The relationship of these microorganisms with each other and the body as a whole ensures a certain microbial homeostasis in dental plaque, in which teeth and periodontal tissues remain intact. Violation of the existing balance under the influence of unfavorable internal and external factors leads to the development of pathology, such as caries.
Among the significant variety of types of dental plaque microorganisms, acid-forming microorganisms are considered potentially cariogenic. According to modern concepts, the most likely infectious agents of the caries process include acid-forming strains St. mutans And Lactobacilli. It is assumed that St. mutans initiates the onset of enamel demineralization during caries. Lactobacilli are included in the process later and are active in caries at the defect stage.
The formation, composition, properties and functions of dental plaque are closely related to the condition of the oral cavity and the body as a whole. Considered to be cariogenic
The potential of dental plaque can only be realized with such general and local risk factors as, for example, excessive consumption of sugar in food, lack of fluoride in drinking water, poor oral hygiene, etc.
The composition and properties of dental plaque are closely related to saliva. The susceptibility or resistance of teeth to caries is determined by such parameters of saliva as the rate of secretion, buffer capacity, concentration of hydrogen ions (pH), bactericidal activity, content of mineral and organic components.
In the process of washing teeth with saliva, substances in plaque and tooth tissue are cleared. Between saliva and tooth enamel, an exchange of calcium and phosphate ions occurs, as a result of which their balance is established in the surface layer of enamel, plaque and saliva. This is facilitated by the oversaturation of saliva with calcium and phosphorus ions.
An important role in protecting teeth from caries is played by the buffer capacity of saliva, which ensures the neutralization of acids and alkalis. The buffering capacity of saliva is based on carbonates, phosphates and proteins.
The concentration of hydrogen ions in saliva is in the neutral range. In dental plaque, the pH in the absence of a cariogenic situation is almost equal to the pH of saliva and is largely controlled by the salivary buffer system.
In addition, due to the buffering ability of saliva, remineralization of the subsurface lesion during caries and the suspension of further demineralization are possible.
Protective function of saliva. Saliva has mineralizing properties. The most direct evidence of this fact is the development of “blooming” caries following the cessation of the functioning of the salivary glands as a result of high-dose irradiation for tumors of the head and neck. Such caries is so destructive that within a few weeks it affects the usually caries-resistant surfaces of the teeth and causes complete destruction of the teeth.
The main properties of saliva that provide protection against caries:
Dilution and clearance of sugars entering the oral cavity with food;
Neutralization of acids in dental plaque;
Source of ions for remineralization of hard dental tissues.
Human teeth do not dissolve in saliva because it is oversaturated with calcium, phosphate and hydroxyl ions. The mineral fraction of teeth consists mainly of these ions. In the dynamic equilibrium of the metabolic process, the supersaturation of saliva with calcium and phosphate ions provides protection
from demineralization. The supersaturated state of saliva is overcome only when the pH of plaque is low enough that the concentration of hydroxyl and phosphate ions falls below a critical value.
Enamel permeability. One of the few physiological properties available for research is the permeability of hard dental tissues and especially enamel.
The permeability of enamel depends on many factors and conditions. There is evidence that some ions can penetrate into crystals and participate in intracrystalline exchange. For example, fluoride displaces the hydroxyl ion in the surface layer of hydroxyapatite crystals in enamel, thereby increasing its acid resistance.
The rate and depth of penetration of substances into the enamel is greatly influenced by the degree of mineralization of hard tissues, which increases with age. In addition, the level of enamel permeability can change under the influence of physical and chemical factors. The speed and depth of penetration of substances into the enamel depend on the nature of the penetrating substance and the time of its contact with the tooth. Fluoride ion penetrates the enamel no more than 15-80 microns.
2.8. CLASSIFICATION OF DENTAL CARIES
In domestic dentistry, they were most widely used topographic classification caries.
1.Initial caries, or caries in the spot stage.
2. Superficial caries.
3. Average caries.
4. Deep caries.
A rational systematization of caries is given in the recommended WHO International Classification of Dental Diseases ICD-C-3, created on the basis of ICD-10, according to which caries (code K02) is classified as follows:
K02.0. Enamel caries. Stage of white (chalky) spot (initial caries). K02.1. Dentin caries. K02.2. Cement caries. K02.3. Suspended dental caries. K02.4. Odontoclasia. Children's melanodentia. Melanodontoclasia.
This section excludes internal and external pathological tooth resorption (K03.3). K02.8. Other specified dental caries. K02.9. Dental caries, unspecified. In ICD-C-3 there is no diagnosis of “deep caries”. Currently, in connection with the transition of clinical dentistry to the ICD classification, the exclusion of the diagnosis of “deep caries” is justified, since the clinical picture and treatment of deep caries fit within the framework of ICD-C-3 and allow deep caries to be classified as dental pulp diseases and considered as initial pulpitis or pulp hyperemia according to code K04.00.
Classification of dental caries proposed by E.V. Borovsky and P.A. Leus (1979), includes the clinical forms of the disease, taking into account the depth of the lesion, localization, course and intensity of the lesion.
CLASSIFICATION OF DENTAL CARIES BOROWSKY-LEUS
2.9. PATHOLOGICAL ANATOMY OF DENTAL CARIES
With caries at the spot stage, a lesion in the form of a triangle is revealed in the enamel, the base of which is facing the outer surface, and the apex is directed towards the enamel-dentin border.
With polarization microscopy, depending on the extent of the lesion in the enamel, from three to five zones with varying degrees of demineralization are determined (Fig. 2.10).
Rice. 2.10. Schematic representation of demineralization zones during caries in the spot stage (polarizing microscopy): 1 - superficial (intact) layer; 2 - body of the lesion; 3 - dark zone; 4 - transparent zone
Zone 1 - surface layer up to 50 microns wide relative to intact enamel.
Zone 2 is the central zone (the body of the lesion), in which demineralization is even more pronounced, the volume of microspaces increases to 25%. Very high degree of enamel permeability.
Zone 3 is a dark zone in which the volume of microspaces lies in the range of 15-17%.
Zone 4 - inner layer, or transparent zone, the volume of microspaces is
0,75-1,5%.
Dentin caries. Dentin caries begins with the destruction of the area of the enamel-dentin junction and spreads along the dentinal tubules towards the pulp. Protective processes occur in dentin and pulp. The dentinal tubules are sclerosed, and the processes of odontoblasts are repelled
are moving in the central direction. As a result of a protective reaction at the border of dentin and pulp, replacement, or irregular, dentin is formed, which differs from normal in the less oriented arrangement of dentinal tubules.
During caries, a violation of the structural integrity of dentin occurs due to demineralization of its mineral component, disintegration and dissolution of the organic matrix. In the focus of carious lesions of dentin, 5 zones are distinguished
(Fig. 2.11).
Rice. 2.11. Damage zones in dentin during dental caries: 1 - intact dentin; 2 - translucent dentin; 3 - transparent dentin; 4 - cloudy dentin; 5 - infected dentin
Zone 1 - normal dentin. In this zone, the structure of the dentinal tubules is not changed; the processes of odontoblasts fill the dentinal tubules.
Zone 2 - translucent dentin. A layer of translucent dentin is formed as a result of demineralization of dentin between the dentinal tubules. In addition, deposition of mineral substances inside the dentinal tubules is observed. Microorganisms are not detected in this zone.
Zone 3 - transparent dentin. The degree of demineralization of this zone is more pronounced. Clinically, this is manifested by softening of dentin. However, some of the collagen fibers remain intact, which may provide the opportunity for remineralization of this area under favorable conditions. There are no microorganisms in this zone.
Zone 4 - cloudy dentin. In this zone, the expansion of the dentinal tubules is determined. Due to significant disintegration of collagen fibers, remineralization of this area of dentin is practically impossible. In this zone, microorganisms are always present in the dilated dentinal tubules. Clinically, the dentin is softened and, as a rule, must be removed.
Zone 5 - infected dentin. The zone of decay of all dentin structures, saturated with microorganisms. This area must be completely removed during treatment. With caries, changes can also occur in the pulp. The severity of these changes depends on the course and depth of the lesion. With caries in the white spot stage and with superficial caries, as a rule, there are no changes in the pulp. If the carious process spreads to dentin, pronounced morphological changes in blood vessels and nerve fibers are found in the pulp. Disorientation and a decrease in the number of odontoblasts are observed. Irritation of odontoblasts leads to the formation of replacement dentin.
2.10. DIAGNOSTICS, CLINICAL PICTURE, DIFFERENTIAL DIAGNOSIS OF DENTAL CARIES
2.10.1. METHODS FOR DIAGNOSIS OF DENTAL CARIES
In case of initial caries, mainly in the white spot stage, it is advisable to visually examine the accessible surfaces of the tooth. Usually, for this purpose, the teeth are cleaned of plaque and dried with a stream of air. As a result of this procedure, areas where there are subsurface defects in the form of white or, to a lesser extent, pigmented spots, differ in color from healthy enamel.
The high permeability of enamel in initial lesions makes it possible to establish the localization and, to some extent, the degree of demineralization during caries in the stain stage by vital staining of tooth tissues. For such a study, it is necessary to clean the tooth surface from plaque, isolate it from saliva and dry it. They are usually stained with a 2% solution of methylene blue. The color intensity of the affected areas after washing off the solution, depending on the degree of demineralization, varies from pale blue to dark blue (Fig. 2.12).
This method is convenient for differential diagnosis of initial caries with non-carious lesions of hard dental tissues (hypoplasia, fluorosis), in which staining does not occur. It can also serve to monitor the effectiveness of remineralization therapy.
To detect initial forms of caries and secondary caries around fillings and inlays, the transillumination method is used: tooth tissue is illuminated through a light guide with a directed beam of light from a halogen lamp. For this purpose they use
special irradiators. The affected areas appear darker when transilluminated.
Rice. 2.12. Foci of enamel demineralization, stained with 2% methylene blue solution
In addition, to diagnose caries, tooth tissue is examined in reflected light and their luminescence in ultraviolet light is used. Recently, the luminescence of hard dental tissues has been determined using laser light sources.
Using the machine "KaVo DIAGNOdent"
For early detection of initial carious lesions, including on hard-to-see surfaces of teeth, the device is used "KaVo DIAGNOdent".
Principle of operation. The laser diode generates pulsed light waves of the red spectrum of a certain length (655 nm). Light waves are concentrated using a fiber-optic element and brought directly to the tooth surface in the form of a beam of cold light using a flexible fiber-optic light guide and a handpiece with special attachments. Pathologically altered tooth tissues reflect light waves of a different length than intact enamel. The length of the reflected waves is analyzed by the electronics of the device. When demineralized tooth tissue is detected, an audible signal appears. The device reacts even to minimal damage to the enamel; diagnostic accuracy is 90%. The fluorescence intensity is determined by numerical values:
0-10 - intact enamel;
10-25 - demineralization within the enamel;
25 or more - dentin caries.
Methodology. The tooth surface is thoroughly cleaned of plaque, isolated from saliva, dried, then the tip of the device with the nozzle is slowly moved along the area under study (the nozzle is placed perpendicularly, in contact with the tooth surface or at a distance of no more than 1.5 mm) (Fig. 2.13). For greater accuracy, repeat measurements are taken to determine the average value.
Rice. 2.13. Diagnosis of early carious lesions using the KaVo DIAGNOdent
The method of probing dental tissues is important, in which the initial stages of enamel damage are determined in the form of areas with a rough surface. As caries progresses
Using this method, you can assess the depth of the lesion and identify areas of pain.
Thermometry is quite informative, which allows for differential diagnosis of various stages of caries and diseases of the dental pulp.
Electroodontodiagnosis (EDD) has a certain significance in the diagnosis of dental caries. This method allows you to determine the condition of the dental pulp. Healthy teeth respond to currents from 2 to 6 μA. With deep caries, electrical excitability of tissues can decrease to 10-15 μA.
To diagnose caries, the X-ray method is widely used, which makes it possible to identify proximal and subgingival carious lesions, secondary caries under fillings, as well as determine the depth of the carious cavity and its relationship with the dental cavity.
Naturally, along with these important methods, the basic research methods - questioning and inspection - are of paramount importance.
2.10.2. CLINICAL PICTURE OF DENTAL CARIES
2.10.2.1. CLINICAL PICTURE OF ENAMEL CARIES AT THE WHITE (CHALKY) SPOT STAGE
(INITIAL CARIES) (K02.0)
2.10.2.2. CLINICAL PICTURE OF ENAMEL CARIES IN THE PRESENCE OF A DEFECT WITHIN ITS LIMITS (K02.0) (SUPERFICIAL CARIES)
2.10.2.4. CLINICAL PICTURE OF INITIAL PULPTIS (PULP HYPEREMIA) (K04.00)
(DEEP CARIES)
2.10.3. DIFFERENTIAL DIAGNOSTICS OF DENTAL CARIES
2.10.3.1. DIFFERENTIAL DIAGNOSTICS OF ENAMEL CARIES AT THE STAGE OF WHITE (CHALKY) SPOT (INITIAL CARIES) (K02.0)
2.10.3.2. DIFFERENTIAL DIAGNOSTICS OF ENAMEL CARIES IN THE PRESENCE OF A DEFECT WITHIN ITS LIMITS (K02.0) (SUPERFICIAL CARIES)
2.10.3.3. DIFFERENTIAL DIAGNOSTICS OF DENTIN CARIES (K02.1) (MIDDLE CARIES)
2.10.3.4. DIFFERENTIAL DIAGNOSTICS OF INITIAL PULPTIS (PULP HYPEREMIA) (K04.00) (DEEP CARIES)
2.10.4. CEMENT CARIES (K02.2)
Along with the crown part, the root of the tooth can also be affected by caries. Root caries mainly occurs in people over 35-45 years of age. If the root is damaged, cement caries (K02.2), root dentin caries (K02.1) may develop, and under certain conditions, caries may be suspended (K02.3).
A prerequisite for the development of root caries is gum recession, as a result of which part of the root is exposed. Great importance is attached to poor oral hygiene. Age, excess carbohydrates in the diet, and inflammatory periodontal diseases play an important role.
The direct cause of cement caries is organic acids that accumulate in dental plaque as a result of the enzymatic activity of cariogenic microorganisms with an excess of carbohydrates in the diet and poor oral hygiene. Plaque pH below a critical level leads to demineralization of the cementum or dentin of the tooth root.
Visually, lesions in cement caries after drying the root surface look like small yellow spots. The cement is thin, so it quickly wears off from the surface of the exposed root area during chewing or hygiene procedures. As a result, cement caries very quickly spreads to the root dentin. Damage to root dentin by caries, as well as cementum in the initial stages, is accompanied by a change in its color as a result of demineralization. The course of root caries is often chronic. The lesion spreads to a greater extent along the surface of the root and to a lesser extent in depth. Usually the process is asymptomatic until the dental pulp is involved. Patients are more concerned about the cosmetic aspect.
Differential diagnosis of caries of cement and root dentin must be carried out with caries of the cervical part of the tooth crown, wedge-shaped defect, and enamel erosion.
Treatment of cement caries and root dentin caries in the initial stages should consist of prescribing rational hygienic procedures and remineralizing therapy. As a result of conservative treatment, subject to good oral hygiene, the affected areas gradually become pigmented, acquiring various shades of brown. The affected tissue becomes dense and shiny. The carious cavity must be filled. The effect of filling largely depends on the patient’s careful adherence to hygiene recommendations. A balanced diet regarding carbohydrates is important.
Carious cavities are prepared according to Black class V. Silver amalgam, glass ionomer cements and composite materials can be used as filling materials.
2.10.5. SUSPENSIVE DENTAL CARIES (K02.3)
It has now been proven that even with an actively ongoing carious process, enamel remineralization occurs simultaneously with pronounced demineralization. Under certain conditions and the degree of demineralization of the enamel, the carious process can stop. A prerequisite for remineralization is the integrity of the organic enamel matrix.
From the anamnesis, it can be found out that areas of discolored enamel exist for a long time. The nature of the defect when several teeth are affected is the same. During the examination, roughness of the enamel surface in the area of the stain is detected, but the integrity of the surface layer is not compromised.
The variety of color shades of carious spots makes it possible to classify white carious spots as rapidly progressing demineralization. Light brown spots are characteristic of intermittent demineralization of enamel, and dark brown and black colors of carious spots indicate a paused demineralization process. Transitional cases are observed when there is a combination of white areas of demineralization with various shades of pigmentation in the area of one spot. This may be due to the unevenness of the processes of demineralization and remineralization in different zones of the carious spot.
It is assumed that caries can stop at any stage of development of a carious spot, however, stabilization or suspension of the demineralization process is possible only when a white carious spot turns into a pigmented one. With white and light brown spots, the pathological process is mainly intermittent.
The appearance of a pigmented substrate is a sign of an intermittent process of demineralization, which depends on the intensity of two opposing processes - demineralization and remineralization and can lead to disintegration or stabilization of the pathological process, a sign of which in most cases is the brown or black color of the spot.
The onset of acid attack on enamel does not necessarily mean the development of a carious defect in it. Due to the buffering properties of saliva, remineralization of partially demineralized
called enamel. The processes of demineralization and remineralization depend not only on local factors (carbohydrates, dental plaque, level of oral hygiene, the presence of fluoride in drinking water), they are closely interrelated with the general condition of the body (age, diseases, etc.), as well as with medical and social factors (lifestyle, education, income, etc.). The general condition of the body affects the development of caries indirectly, through saliva, by changing the rate of secretion, its quantity and the buffering properties of the oral fluid.
Of great importance in the development of suspended caries is the preservation of the outer, largely intact surface layer of enamel, which, having the properties of an ion-selective membrane, provides the possibility of not only the development of a subsurface focus of demineralization, but also remineralization.
With a white carious spot, if the cariogenic situation is eliminated, the reverse development or suspension of demineralization can occur independently due to the remineralizing properties of the oral fluid or as a result of the use of remineralizing drugs.
With a pigmented carious spot, which is a stabilized stage of caries, remineralizing therapy, as a rule, has no effect. The dentist’s tactics in the presence of a pigmented spot may be as follows. In cases where carious spots are small in area or are located in places accessible to hygienic procedures, dynamic monitoring of their condition is possible. In other cases, especially when spots are localized on contact surfaces, it is advisable to excise the altered tissues with subsequent filling of the defect.
CLINICAL SITUATION 1
A 30-year-old patient came for a preventive examination. Upon examination of the oral cavity, it was revealed that the gums were hyperemic, swollen, and bleeding upon probing. The teeth are covered with a soft coating. After removing the plaque on the vestibular surface in the cervical area of teeth 13, 33, 32, 31, 41, 42, white chalky spots and loss of natural shine of the enamel were discovered. Changes in the color of the enamel of the corresponding teeth had not previously been detected.
1.What lesions does this pathology relate to?
2. Make a diagnosis.
3.What additional diagnostic methods can be used?
4. Conduct a differential diagnosis of dental diseases.
5.Make a treatment plan for this disease.
CLINICAL SITUATION 2
The patient came for a preventive examination. An examination of the oral cavity revealed that the gums were pale pink and moderately moist. On the chewing surfaces of teeth 35, 36, 47 there are pigmented fissures. Probing is painless; the probe remains in the fissure.
1.Make an examination plan.
2. Carry out a differential diagnosis of dental diseases.
3. Make a diagnosis.
GIVE ANSWER
1. Criteria for assessing carious lesions:
4) intensity of dental caries;
5) rate of saliva secretion.
2. Enamel permeability increases with the following diseases:
1) fluorosis;
2) enamel erosion;
3) caries in the stage of a white carious spot;
4) dentin caries;
5) generalized periodontitis of moderate severity.
3. Stefan's curve reflects:
1) dynamics of changes in saliva viscosity during caries;
2) changes in the rate of saliva secretion during caries;
3) hygienic condition of the oral cavity;
4) dynamics of changes in the pH of dental plaque under the influence of carbohydrates;
5) the degree of enamel permeability during dental caries.
4. Vital staining of hard tooth tissues is carried out:
1) for the purpose of diagnosing caries in the stage of a white carious spot;
2) for the treatment of caries in the stage of a white carious spot;
3) for the diagnosis of dentin caries;
4) to determine the hygienic state of the oral cavity;
5) for the purpose of diagnosing chronic periodontitis.
5. The following complaints are typical for dentin caries:
1) night pain;
2) paroxysmal pain;
3) short-term pain from chemical irritants;
4) constant aching pain;
5) pain during percussion.
6. According to the ICD-C-3 classification, caries is distinguished:
1) average;
2) deep;
3) enamel caries;
4) superficial;
5) rapidly progressing caries.
7. The color of carious spots is characterized by:
1) duration of caries;
2) degree of caries activity;
3) the depth of damage to the hard tissues of the tooth;
4) the degree of involvement of dentin in the process;
5) transition of enamel caries to dentin caries.
8. The cavity with dentin caries is located within:
1) dental pulp;
2) dentin;
3) enamel and dentin;
4) enamels;
5) periodontium.
9. For dentin caries, cavity probing:
1) painful in all areas;
2) painful in the area of the cavity bottom;
3) painless in all areas;
4) painful at one point;
5) painful in the area of the enamel-dentin junction.
10. To determine the intensity of caries use:
2) assessment of the prevalence of caries;
RIGHT ANSWERS
1 - 4; 2 - 3; 3 - 4; 4 - 1; 5 - 3; 6 - 3; 7 - 2; 8 - 3; 9 - 5; 10 - 4.
Dental caries still remains one of the most common dental pathologies. Timely diagnosis of caries is based on identifying the initial stages of enamel demineralization and clear differentiation of healthy and damaged hard dental tissues. Analysis of the prevalence and intensity of the disease, as well as the effectiveness of preventive measures, is carried out on the basis of indicators of the prevalence and intensity of dental caries. Determining these indicators is an integral part of the practical work of a dentist.
The effectiveness of the prevention and treatment of caries is assessed using indicators of the prevalence of the carious process, the intensity of caries of teeth and surfaces, the increase in intensity, the level of caries intensity, the level of dental care, etc.
Prevalence of dental caries– this is the ratio of the number of people with at least one of the signs of dental caries (carious, filled or extracted teeth) to the total number of those examined, expressed as a percentage.
To determine the prevalence, the number of people diagnosed with dental caries (except for focal demineralization) is divided by the total number examined in this group, and the result is multiplied by 100.
In order to assess the prevalence of dental caries in the group examined or compare the value of this indicator in different regions, WHO assessment criteria for 12-year-old children are used (Table 2):
Caries prevalence levels
| short | 0-30% |
| average | 31-80% |
| high | 81-100% |
One of the main indexes is intensity of dental caries damage. For this purpose, the determination of quantitative values of the KPU is used, where K is the number of carious (untreated) teeth, P is the number of treated (filled) teeth, Y is the number of removed teeth or tooth roots to be removed. The sum – (K + P + U) – of all affected and lost teeth characterizes the intensity of the carious process in a particular person. There are three varieties of this index: KPU of teeth (KPUz), when only the number of carious and filled teeth of the subject is counted, KPU of surfaces affected by caries (KPU pov.) and KPU of cavities (KPpU), when the absolute number of carious cavities and fillings in teeth is calculated. This indicator is more sensitive than the first two. For temporary teeth the indicator CP is calculated - the number of carious and filled teeth of the temporary occlusion or, respectively, CP of surfaces (surfaces) and CP - the number of carious cavities and fillings. Teeth removed or lost as a result of physiological change are not taken into account in the temporary dentition. For mixed dentition in children Two KP indices are calculated - for temporary and KP - for permanent teeth. The total intensity of dental caries damage is calculated by summing the indexes KP + KPU.
Depending on the values of the KPU index, five levels of intensity of dental caries are distinguished: very low, low, medium, high and very high (Table 3).
In 1972, T.F. Vinogradova, based on a clinical analysis of the dynamics of the development of dental caries in children, proposed a classification of dental caries, providing for the identification of three degrees of activity: first, second and third degrees or compensated, subcompensated and decompensated forms (Table 4). The author argues that with this approach to assessing the activity of the pathological process, dental caries is considered as a chronic pathological process of the body, characterized by focal demineralization of tooth tissue with the formation of a carious cavity in the tooth, capable of worsening throughout the child’s life, stabilizing, acquiring different activity and being in varying degrees compensation of a chronic pathological process. The carious cavity is the leading clinical symptom of a chronic pathological process.
| Age | index | 1 degree of activity (compensated) | 2nd degree of activity (subcompensated) | 3rd degree of activity (decompensated) |
| 3 – 6 | kp | Less than 3 | 3 – 6 | More than 6 |
| 7 – 10 | KPU+KP | Less than 5 | 6 – 8 | More than 6 |
| 11 – 14 | CPU | Less than 4 | 5 – 8 | More than 8 |
| 15 – 18 | CPU | Less than 7 | 7 – 9 | More than 9 |
| Tactics: | Inspection once a year. Carrying out preventive measures - fissure closure and fluoride prophylaxis. | Inspection and sanitation at least 2 times a year. | Sanitation at least 3 times a year. It is necessary to consult a pediatrician, prescribe oral anti-caries drugs, and recommendations on rational hygiene and nutrition. |
The number of carious teeth and the number of carious cavities, their location, identified during the examination, the increase in carious teeth, carious cavities after a year ( increase in intensity) are considered as symptoms of caries, allowing on their basis to determine the degree of activity of the pathological process.
1The article presents the results of a dental examination of 625 children living in the city of Ufa. The survey used a questionnaire for parents, which included questions about awareness of oral hygiene issues, risk factors for dental diseases, and diet. The results of epidemiological dental examinations indicate a fairly high (according to WHO criteria) prevalence of caries in both temporary and permanent teeth of 6, 12 and 15 year old children in the city of Ufa, a high prevalence of periodontal diseases and dental anomalies. As a result of the dental examination and questionnaire, a high prevalence of major dental diseases in children and a low level of dental education of parents were established, which requires improvement of existing preventive measures in this population group.
prevalence
periodontal diseases
dental anomalies
survey
oral hygiene
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The main task of the state and, first of all, its healthcare services is to ensure the health of the nation, organize and implement the most effective programs for the prevention of major and most common diseases.
Dental status is one of the main indicators of the general condition of the body, and the development of a system of measures aimed at reducing dental morbidity rates should be an integral part of programs for improving the health of the nation.
The dental aspect of public health is characterized by two main indicators - prevalence and intensity, reflecting quantitative signs of diseases of the teeth, gums, level of hygiene, etc.
Currently, dental morbidity in our country among the child population is quite high, and further deterioration should be expected unless the conditions influencing the development of oral diseases are changed in a favorable direction and the quality of dental care, which depends on many objective factors, is not improved. and subjective factors.
One of the pressing health problems is the issue of assessing the quality of dental care provided to the population. This is especially true for the provision of dental therapeutic care to children, in particular in the treatment of such common diseases as dental caries and periodontal diseases. When assessing the quality of dental care, environmental and epidemiological factors must be taken into account.
Identification and elimination of etiological factors, targeted impact on the stages of development of pathology, allows you to obtain the maximum therapeutic and preventive effect, and, therefore, will have a positive impact on the quality of dental care.
At the same time, epidemiological studies conducted in various cities of Russia show an increase in the prevalence and intensity of dental caries depending on age and the epidemiological situation.
An epidemiological survey of the child population is the main point in the analysis of dental morbidity, which is necessary to compare morbidity in different regions, determine the quality of dental care, plan preventative treatment programs and evaluate their effectiveness. The main goal of prevention is to eliminate the causes, conditions for the occurrence and development of diseases, as well as increase the body’s resistance to the effects of adverse environmental factors.
The purpose of the study was a study of the dental status of children living in the city of Ufa, with the aim of improving the quality of dental care.
Material and methods of examination
To assess the condition of teeth, the indicators recommended by the WHO expert committee were used.
The prevalence of dental caries was determined using the formula:
Number of people with caries
Prevalence = ———————————————— x 100%
Total number of examined
The intensity of dental caries during the period of temporary dentition was determined using the KP index, during the period of mixed dentition using the KP+KPU index, and during the period of permanent dentition - KPU. To assess the prevalence and intensity of dental caries in children aged 12 years, we used the criteria recommended by the WHO Regional Office for Europe (T. Martthaller, D. O'Mullane, D. Metal, 1996).
The condition of periodontal tissues was studied using the periodontal index KPI (Leus P.A., 1988). The hygienic state of the oral cavity in children was assessed using the Fedorov-Volodkina index and the simplified oral hygiene index (IGR-U) (J.C. Green, J.R. Vermillion, 1964). Anomalies of teeth, dentition, jaws and occlusion were considered according to the classification of the Department of Orthodontics and Children's Prosthetics of the Moscow State Medical and Dental University (1990).
The survey used a questionnaire that included questions about children’s awareness of oral hygiene, risk factors for dental diseases, and diet.
Results and discussion
The overall prevalence of caries in primary teeth in 625 children aged 6–15 years was 57.86±1.56%, the intensity of caries in primary teeth was 2.61±0.6. The overall prevalence of caries in permanent teeth in 625 children aged 6 to 15 years was 71.45±1.31 %, and the intensity of caries of permanent teeth is 2.36±0.52. At 6 years of age, the prevalence of caries in primary teeth was 92.19%±2.94. At the age of 12 years, it was 16.4±3.18 %, and at 15 years old it is 4.02±1.92%. A different trend was observed in the prevalence of caries in permanent teeth: from 6 to 15 years of age there was a gradual increase in the process, so if at 6 years the prevalence was 18.64±3.75%, then by 12 years it was 84.28±3.27%, which corresponds to a high prevalence of dental caries. By the age of 15, the prevalence reaches its maximum value - 88.21±3.3%.
Table 1 shows average data on the prevalence and intensity of caries in permanent teeth among key age groups in the city of Ufa.
Table 1
Prevalence and intensity of caries in permanent teeth among key age groups in children in the city of Ufa (according to WHO criteria)
Analysis of the survey results shows that with age there is a tendency for caries of permanent teeth to increase - from 18.64±3.75% among 6-year-olds to 88.21±3.3% among 15-year-olds. In 12-year-old children, the average intensity of caries in permanent teeth is 2.83±1.58. In the structure of the KPU index in 12-year-old children, the “U” component (teeth removed due to caries and its complications) appears, which increases with age; the “K” component (caries) predominated, which was equal to 1.84 ± 0.14, while the “P” component (filling) is only 0.98 ± 0.09. At the age of 15, the “P” component predominates and is equal to - 2.25 ± 0.15, and component “K” - 1.67 ± 0,13. Among the identified dental disorders, periodontal diseases occupy second place. Analysis of the results shows a high prevalence of periodontal diseases, which increases with age. 53.44% of 6-year-old children show signs of periodontal disease. In 12-year-old children, the prevalence of periodontal disease is 80.28%. 19.72% of children are at risk of the disease. The intensity of periodontal lesions in 12-year-old children was 1.56. Among 15-year-old children, the prevalence rises to 85.5%. 14.5% have a risk of developing the disease. The intensity of periodontal diseases increases to 1.74. 65.26% of 12-year-old children have a mild degree of periodontal damage and need training in the rules of oral hygiene, 15.02% of children have a moderate degree of periodontal damage, and these children need professional oral hygiene. Among 15-year-old children, these values are 66.0% and 19.5%, respectively.
The average value of the Fedorov-Volodkina index in the temporary dentition of 6-year-old children was assessed as an unsatisfactory level of oral hygiene.
The average value of the Green-Vermillion index in children in the mixed dentition was 1.48, in the permanent dentition - 1.56. Also, in children, both in the mixed and permanent dentition, increased deposition of tartar was noted.
When examining children in the city of Ufa, the age-specific dynamics of the prevalence of dental anomalies and deformities were studied. At the age of 6 years, the lowest prevalence of 40.05 ± 2.56% of anomalies in the dental system was found. Growth continues up to 12 years, where the maximum prevalence of dentoalveolar anomalies and deformities was found to be 77.20 ± 2.75%. At 15 years of age there is a slight decline to 75.50±3.01%. We compared the prevalence of dental anomalies and deformities between boys and girls. The overall prevalence for girls was 71.63±1.23%, and for boys 68.21±1.42% (P>0.05); there were no significant differences in the prevalence of pathologies in the dental system in boys and girls. When studying age-related dynamics in boys and girls, no significant differences were revealed (Table 2).
table 2
Prevalence of dental anomalies and deformities depending on gender in children living in the city of Ufa
We conducted a survey of 614 parents of schoolchildren living in the city of Ufa in order to determine the level of sanitary and hygienic knowledge, frequency and reasons for seeking dental care, and medical activity in the prevention of dental diseases.
When asked at what age it is necessary to brush a child’s teeth, only 18.79% of parents answered that teeth should be brushed from the moment teeth emerge. 39.24% believe that teeth should be brushed from the age of 2, 25.44% - from the age of 3, 20.53% of the surveyed parents answered that teeth should be brushed from the age of 4 and older.
Of the answer options proposed in the questionnaires regarding the hygiene products used by the child, 99.52% of the surveyed parents indicated that they use a toothbrush and toothpaste for oral care, of which 45.93%, in addition to basic hygiene products, use additional products (chewing rubber bands, mouthwash, toothpicks, floss). 0.32% of children do not brush their teeth. Oral care is carried out twice a day by 51.14% of children, once a day by 47.55%, after each meal by only 0.98%. 0.33% of children brush their teeth occasionally.
As for the frequency of visits to the dentist by a child, 23.62% visit the dentist once every six months or more often, 2.26% of people answered that they do not visit the dentist at all. The majority of parents, 55.66%, go to the dentist when their child has a toothache. Once a year - 16.69%, once every two years only 1.77% of respondents.
The information we received about preventive measures has a certain theoretical and practical interest. 51.27% of the surveyed parents answered that the dentist did not tell them about the need for preventive measures for the child, the remaining 48.78% of the parents answered that yes, the dentist did.
66.19% of people believe that their child needs measures to prevent dental diseases, 17.7% of parents answered no, and 16.19% do not know. 77.72% of parents are ready to participate in activities to prevent dental diseases, the remaining 22.28% are not. 33.38% of parents always follow the doctor’s recommendations for the prevention of dental diseases, 47.59% do not always fully and not always in a timely manner, 9.05% do not have enough time, 8.84% do not have enough money for effective hygiene products oral cavity, 0.78% of parents believe that the doctor is not competent enough, and 0.35% do not believe in prevention. When asked which methods of health education you trust most, the answers were distributed as follows: an individual conversation with a doctor - 88.76%, television and radio programs - 2.83%, 4.74% - read literature and health bulletins, 3.68% listen to lectures by specialists at the clinic.
Thus, we have identified a low level of sanitary and hygienic knowledge among parents, insufficient medical activity of parents regarding the preservation of dental health in the child, and insufficient work by dentists on hygienic education and health education of the population on the prevention of dental diseases. On the other hand, a high level of public trust in information received from dentists was revealed. A dentist must know about oral hygiene products, be able to give recommendations on the correct choice and use of products in accordance with their dental status, and must instill in patients a motivated attitude towards oral hygiene as an integral part of the health of the body.
Thus, the high prevalence of major dental diseases requires the modernization of existing preventive programs for organized groups of the population.
Bibliographic link
Averyanov S.V., Iskhakov I.R., Isaeva A.I., Garayeva K.L. PREVALENCE AND INTENSITY OF DENTAL CARIES, PERIODONTAL DISEASES AND DENTAL ANOMALIES IN CHILDREN OF THE CITY OF UFA // Modern problems of science and education. – 2016. – No. 2.;URL: http://site/ru/article/view?id=24341 (access date: 02/01/2020).
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Dental caries (caries dentis; from the Latin caries - decay) is a pathological process that is manifested by demineralization and progressive destruction of hard tooth tissues with the formation of a defect in the form of a cavity.
Caries has been known since ancient times. Information about this disease appeared in written sources around 3000 BC. e. At that time, caries was not yet so widespread, but in the Middle Ages it began to affect more and more people. This is associated with changes in nutrition, environmental and living conditions. Thus, starting from the 18th century, the frequency of caries begins to increase sharply, and in our time its prevalence in some regions of the globe reaches 100%. There are different levels of caries incidence - from 1-3% in Western European countries to 80-97% in Africa, Asia, and the CIS. This is explained by a number of factors: the nature of the diet (primarily an excess of carbohydrates and a relative lack of proteins in the diet), fluorine content (0.8 mg/l in hot countries, 1 mg/l in temperate climates, 1.5 mg/l in northern latitudes) and other macro- and microelements in drinking water, social and climatic-geographical conditions.
In epidemiological studies, a number of indicators are used to assess the condition of teeth when they are affected by caries: the prevalence of caries, the intensity of the process, morbidity (increase in intensity over a certain period of time).
Prevalence of caries.
It is calculated by dividing the number of people who have carious, filled and extracted teeth (regardless of the number of carious teeth in each of them) by the total number of those examined and is expressed as a percentage:
The intensity of caries damage in one examined person is determined by the index of dental CP of teeth and CP of cavities. The CPU index of teeth is the sum of carious (C), filled (P) and removals due to complications of caries (U) teeth in one examinee. When determining this and other average values of intensity indices for a significant number of the population, their sum is divided by the number of those examined. When determining the CPU index, a tooth containing one or more cavities is considered to be affected by caries, filled with one or more fillings, regardless of their size and condition. If a tooth has both a filling and a carious cavity, then it is considered carious. In children, the index is calculated depending on the occlusion: in the permanent dentition, the permanent teeth affected by caries are taken into account (index KPU), in the temporary (milk) - index kp (carious and filled) and in the mixed dentition - permanent and temporary teeth (KPU + kp) .
KPU index.
It is a fairly informative indicator that allows one to judge the level of caries intensity. According to WHO recommendations, there are five levels of caries intensity: very low, low, medium, high and very high.
Sometimes, for a more complete and accurate assessment of the condition of the teeth, the CPP (cavity) index is calculated, which takes into account the number of carious cavities and fillings. Unlike the tooth index, the total number of carious cavities and fillings is calculated, regardless of the number of affected teeth. That is, if one tooth has three separate carious cavities, then in the CP index of teeth it is counted as one, and in the CP index (cavities) - as three units. This index is especially indicative at low intensity of caries damage.
Morbidity (increase in caries and its intensity) - the average number of new teeth affected by caries, which are determined over a certain period of time, based on one person examined. Typically, the increase in caries is determined after one year, and with the active course of the pathological process - after 6 months.
Epidemiological indicators.
The incidence of caries during mass dental examinations of the population should be taken into account in different age groups. This is due to the different susceptibility to caries in children and the presence of temporary teeth. Accordingly, they should be taken into account in adults as well. According to WHO recommendations, adults are divided into the following age groups: young, middle-aged and elderly.
The prevalence and intensity of caries in the population depends on a number of factors. Very important are geographical factors, which include climate, solar activity, the content of various minerals (calcium, phosphorus) and some trace elements (fluorine) in the soil and drinking water.
According to modern ideas, one of the main reasons
The occurrence of caries is due to irrational, unhealthy diet. Typically, the diet is dominated by overly processed, refined foods high in carbohydrates. When cooking food, a large amount of substances necessary for the body is lost. An imbalance of nutrition leads to insufficient intake of essential components into the body: vitamins, amino acids (lysine, arginine), etc. The importance of a balanced diet is confirmed by data from epidemiological, clinical and experimental studies.
The prevalence of caries also depends on a person’s age, which is due to the different number of teeth in children and adults and the susceptibility of tissues to caries (temporary teeth are more easily affected than permanent teeth). This is taken into account during the study. In children, a rather low CP + CP index can be regarded as an indicator of a very intense carious process due to premature removal of baby teeth. There were no significant gender differences in the prevalence and intensity of caries. Only in certain periods of life, for example, during pregnancy, do women have an increased tendency to caries, which can result in an increase in the number of teeth affected by caries.
General condition of the body.
In particular, past and concomitant diseases have a certain impact on the incidence of dental caries. Its high frequency has been noted in children who have suffered infectious diseases or have diseases of internal organs. Changes in the general and immunological reactivity of the body have a significant impact on the occurrence of caries.
The hygienic condition of the oral cavity and the level of dental care are one of the important factors in the occurrence of caries. Regular dental care using modern preventive and hygiene products is a very effective method of preventing dental caries. To a certain extent, uneven cleaning of teeth leads to an increase in the incidence of caries in them. Often, caries affects teeth whose crowns have a rather complex anatomical shape (a large number of fissures, pits), etc. According to the frequency of damage to individual teeth by caries (I. O. Novik, 1958), they can be placed in this way: first molars, second and third molars, premolars, upper incisors, lower incisors, canines. Analysis of the CP index (cavities) allows us to identify the surfaces of the teeth that are most often affected by the carious process. In permanent teeth, caries is usually localized on contact, chewing surfaces and in the cervical area. Caries is also characterized by symmetrical damage to teeth, which is explained by the identity of the conditions and their anatomical structure.
The sensitivity of teeth to caries is also affected by a violation of the structure of their hard tissues, which is often a consequence of general diseases, systemic disorders of the body, etc.
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