One of the main indexes (KPU) reflects the intensity of tooth decay by caries. K means the number of carious teeth, P - the number of filled teeth, Y - the number of teeth removed or to be removed. The sum of these indicators gives an idea of the intensity of the carious process in a particular person.

There are three types of KPU index:

· KPU teeth (KPUz) - the number of carious and sealed teeth of the subject;

· KPU surfaces (KPUpov) - the number of surfaces of teeth affected by caries;

· KPUpol - the absolute number of carious cavities and fillings in the teeth.

For temporary teeth, the following indicators are used:

kn - the number of carious and filled teeth of temporary bite;

kn - the number of affected surfaces;

· KPP - the number of carious cavities and fillings.

Teeth removed or lost as a result of a physiological change in the temporary occlusion are not taken into account. In children, when changing teeth, two indices are used at once: kp and kp. To determine the overall intensity of the disease, both indicators are summed up. KPU from 6 to 10 indicates a high intensity of carious lesions, 3-5 - moderate, 1-2 - low.

These indices do not give a sufficiently objective picture, as they have the following disadvantages:

take into account both cured and extracted teeth;

Can only increase with time and with age begin to reflect the past incidence of caries;

Do not allow to take into account the most initial carious lesions.

Serious shortcomings of the KPUz and KPUpov indices include their unreliability with an increase in tooth lesions due to the formation of new cavities in the treated teeth, the occurrence of secondary caries, loss of fillings, and the like.
The prevalence of caries is expressed as a percentage. To do this, the number of persons who have found certain manifestations of dental caries (except for focal demineralization) is divided by the total number of those examined in this group and multiplied by 100.
In order to estimate the prevalence of dental caries in a given region or to compare the value of this indicator in different regions, the following criteria are used to estimate the prevalence rate among 12-year-old children:
INTENSITY LEVEL
LOW - 0-30%
MEDIUM - 31 - 80%
HIGH - 81 - 100%
To assess the intensity of dental caries, the following indices are used:
a) the intensity of caries of temporary (milk) teeth:
kp index (z) - the sum of teeth affected by untreated caries
and sealed in one individual;
kn index (n) - the sum of surfaces affected by untreated
caries and fillings in one individual;
In order to calculate the average value of the kp(s) and kp(p) indices in the group of subjects, it is necessary to determine the index for each subject, add up all the values and divide the resulting amount by the number of people in the group.
b) the intensity of caries in permanent teeth:
index KPU (z) - the sum of carious, sealed and removed
teeth in one individual;
KPU index (p) - the sum of all tooth surfaces on which
diagnosed caries or filling in one individual. (If
the tooth is removed, then in this index it is considered as 5 surfaces).
When determining these indices, early forms of dental caries in the form of white and pigmented spots are not taken into account.
In order to calculate the average value of indices for a group, one should find the sum of individual indices and divide it by the number of patients examined in this group.
c) assessment of the intensity of dental caries among the population.
To compare the intensity of dental caries between different regions or countries, average values of the KPU index are used.

11. Superficial formations on the teeth and dental deposits. Classification. The role of dental deposits in the physiology and pathology of the oral cavity.

In the emergence and especially the development of major dental diseases - dental caries and periodontal lesions - an essential role is assigned to the acquired structures of the oral cavity. In developing directions for the etiotropic and pathogenetic prevention of dental diseases, it is necessary to take into account the characteristics of these structures, their physiological and pathogenic effects on the organs of the oral cavity.

In the literature up to the present time, there is no single terminology that objectively characterizes the acquired structures.

The most objective grouping of acquired structures is reflected in the classification of G. N. Pakhomov, according to which they are combined into two large groups:

I. Non-mineralized dental deposits:

a) pellicle

b) dental plaque

c) soft plaque,

d) food residues (detritus);

II. Mineralized dental deposits:

a) supragingival tartar,

b) subgingival tartar.

Tooth pellicle is an acquired thin organic film that replaces the congenital nasmite sheath that covers the tooth after it has erupted. The pellicle is a structural element of the surface layer of enamel and can only be removed with strong abrasives. The pellicle is difficult to detect with the naked eye, bacteria quickly colonize on its surface and dental plaque forms.

Dyes, such as erythrosin, are commonly used to detect the pellicle in the clinical setting. Under the influence of erythrosin, the pellicle acquires a bright red color. A stained pellicle can often be found in the clinic under the influence of chromogenic bacteria, when smoking, using a number of drugs, etc.

The pellicle is free from bacteria and consists of glycoproteins. In the oral cavity, when the tooth comes into contact with saliva, it can form in 20-30 minutes. The pellicle is of great importance in the processes of diffusion and permeability in the surface layer of enamel, in protecting the teeth from the action of dissolving agents. It gives the enamel selective permeability. However, under adverse situations in the oral cavity, the pellicle can swell, change its composition and properties, and in this state favor the development of dental caries.

The pellicle has selective permeability. This biological membrane can regulate the diffusion of various solutions from saliva into the tooth and from the tooth into saliva. The condition of the pellicle can serve as a factor, either accelerating the onset of caries, or, conversely, enhancing enamel remineralization.

Recently, the clinical role of the pellicle under the influence of various anti-caries agents, in particular fluorine preparations, has been intensively studied. It was found that the pellicle delays the return of fluorides from the enamel. In addition, it helps to regulate the flow of fluorine into the enamel in order to form stronger compounds - fluorapatites.

dental plaque- This is a colorless formation that is located above the pellicle of the tooth. It can be detected only with special staining. The plaque is not washed off and is practically not removed when brushing your teeth. It can only be scraped off with special dental tools (excavator, trowel). It is in the dental plaque that the active vital activity of microorganisms occurs, accompanied by acid formation, enzymatic activity and other metabolic processes of microorganisms. Often, after removing the plaque, you can find an area of demineralized enamel with a changed color.

Plaque is a soft, amorphous, granular deposit that accumulates above and below the gum on tooth surfaces, dentures, and tartar. Plaque formation begins with the attachment of a monolayer of bacteria to the pellicle or enamel using a sticky interbacterial matrix. It consists mainly of microorganisms, epithelial cells, leukocytes and macrophages. The main inorganic components of the matrix are calcium and phosphorus. Magnesium, sodium and potassium are found in limited quantities. Plaque growth is carried out by adding new colonies of microorganisms.

Plaque is not a food residue, but plaque bacteria use the nutrients introduced into the oral cavity to form matrix components. The most readily utilized nutrients are those that readily diffuse into the plaque. These are sucrose, glucose, fructose, maltose, lactose. Starches serve as a bacterial substrate. Plaque develops quickly with soft foods, while foods that are difficult to chew delay its formation. The accumulation in the plaque of end products of bacterial metabolism (acids or nitrogenous substances) depends on the rate of their formation and release from the plaque.

Soft plaque - is a local irritant and often the cause of chronic inflammation of the gums. It is a yellow or grayish-white soft and sticky deposit that does not adhere tightly to the surface of the tooth. Soft plaque can be seen without special staining solutions. Plaque is deposited on the surface of teeth, fillings, stones and gums. A particularly large amount of plaque is observed on teeth that are incorrectly located in the dentition. Soft plaque can form on previously cleaned teeth for several hours even when food is not taken.

Plaque can be washed off with a stream of water, but mechanical cleaning is required to ensure its complete removal. Previously it was thought that plaque consisted of stagnant food detritus, but it is now established that the white matter is a conglomerate of microorganisms, constantly exfoliating epithelial cells, leukocytes, a mixture of salivary proteins and lipids with or without food particles.

Soft plaque, unlike plaque, does not have a permanent internal structure. Its irritating effect on the gums is associated with bacteria and their metabolic products. It has been established that the toxicity of plaque for experimental animals persists even after the destruction of the bacterial component by boiling.

In connection with oral hygiene, eating, especially hard and dense, part of the plaque from the surface of the teeth and gums is constantly removed, but it is quickly formed again. During its stay in the oral cavity with plaque, a number of qualitative changes occur. It “ages” over time, and this process is accompanied by increased mineralization. Therefore, partially mineralized plaque should be considered old and its presence is an indicator of poor oral hygiene.

Detection methods and quantification of acquired oral structures are based on a chemical reaction or sorption of dyes with extracellular polysaccharides of deposits. Most often, “Bismarck brown”, tablets and solutions of erythrosine, a solution of basic fuchsin are used for these purposes:

Iodine in a solution of potassium iodide stains plaque and plaque polysaccharides in yellowish-pink tones as a result of the formation of complex compounds. Apply Lugol's solution in the form of periodontal applications with small cotton swabs on the vestibular surface of the teeth.

With a solution of basic fuchsin, plaque is stained by vigorously rinsing the mouth for 30 seconds. The plaque at the same time is painted in a dirty red color. Erythrosine can be used as a tablet that moves vigorously in the mouth for 30 seconds or as a mouth rinse with a solution. The plaque is painted in an intense red color.

Plaque can be quantitatively and qualitatively assessed using the Fedorov-Volodkina index. Pakhomov G. N. proposed to determine this index not on 6, but on 12 teeth of the upper and lower jaws, which makes it possible to more accurately assess the property of oral hygiene.

Several dozens of methods for assessing oral hygiene are described in the literature, but all of them are basically similar to the one described and differ only in details and purpose.

food leftovers- This is the fourth layer of dental deposits. Food particles are most often located in retention areas. They are easily removed by moving the muscles of the lips, tongue, cheeks, and rinsing the mouth. When soft food is consumed, its remains can undergo fermentation, decay, and the resulting products contribute to the metabolic activity of dental plaque microorganisms. However, the plaque is not a direct product of the decomposition of food residues. Sticky foods - bread, sweets, confectionery with a high content of butter, margarine remain on the tooth surface for more than 1 hour.

Mineralized dental deposits (tartar) are also an acquired structure of the oral cavity. Back in the 10th century, they were considered as the cause of periodontal disease. Depending on the location on the surface of the tooth, supra- and subgingival tartar is distinguished.

supragingival stone located above the crest of the gingival margin, it is easy to detect on the surface of the teeth. This calculus is usually white or whitish-yellow in color, hard or clay-like in consistency, easily separated from the tooth surface by scraping or chipping. Its color depends on food pigments or tobacco (in smokers). The stone can be found on one tooth, a group of teeth, or on all teeth, most often on those surfaces that are located near the mouths of the excretory ducts of the salivary glands. Supragingival calculus is formed in varying amounts in all people, but with age, its number increases.

In the mechanism of formation of supragingival calculus, an important role is played by insoluble calcium-phosphorus compounds from saliva on the basis of detritus of the oral cavity. That is, the supragingival stone is referred to as the salivary type. It consists of inorganic (70-90%) and organic components. The inorganic part is represented by calcium phosphates and carbonates, as well as trace amounts of other metals and microelements. The organic component of the stone is represented by exfoliated epithelium, leukocytes, microorganisms. About 10% of the organic part of the stone is carbohydrates (galactose, glucose, manose, etc.).

subgingival the stone is usually invisible, as it is located under the gum in the resulting pathological gingival pocket. Accurate probing is necessary to determine the location and extent of the subgingival calculus. This calculus is usually dense and hard, dark brown or greenish black in color and firmly attached to the root surface of the tooth.

A subgingival stone is formed only in the cervical area and on the surface of the tooth root when a pathological periodontal pocket occurs. It has now been proven that the source of mineral components for this stone is the gingival fluid, which resembles blood serum. The composition of the subgingival stone is similar to that of the supragingival one. In its structure, it is a mineralized dental plaque.

quantitative Tartar assessment is based on the same principles as plaque detection, but is less commonly used. Tartar can be well stained with magenta. Most often, diagnostic dyes are used to control the completeness of stone removal. To do this, it is recommended to use a 6% solution of basic fuchsin for applications or a 0.75% solution for rinsing for 20 seconds. You can also use Lugol's solution and other dyes.

All dental deposits in the oral cavity, with the exception of the pellicle, are infected and play a negative role in the development and maintenance of foci of infection. In order to maintain the oral cavity in a healthy state, dental deposits need timely and high-quality removal. This medical manipulation is preventive in relation to diseases of the teeth and periodontium. Food debris and soft plaque can be removed by vigorous rinsing, rinsing with water, and thorough and proper brushing of the teeth, especially during professional oral hygiene steps. These acquired structures can be removed by a dentist with a cotton swab and special devices. Removal of hard dental deposits and dental plaques is usually carried out mechanically using excavators, trowels or specially designed hook tools, enamel knives.

Carious process - a disease that affects dental tissues, characterized by their destruction with the formation of cavities. In today's world, every person at least once met with him. The disease is widespread due to the unbalanced diet of a large number of the population.

For epidemiological studies, several indicators are used: incidence, prevalence of caries and intensity. They compare different regions, with the help of which the quality of treatment and prevention of the disease is determined, and an individual therapy plan for the patient is drawn up.

What are caries statistics?

The prevalence and intensity of caries, its growth are the main statistical indicators of the disease. The prevalence is expressed as a percentage and is found by the algorithm. The number of persons with carious lesions of dental tissues is divided by the number of subjects, the obtained data is multiplied by 100.

The disease index shows the development of the disease individually for each patient. It is determined by the number of affected and already cured teeth. To calculate the index of a group of people, it is necessary to determine the individual indices, and then find their arithmetic mean.

However, scientists suggest that the figures for the intensity of the disease, calculated by the existing algorithm, do not correspond to reality. They do not take into account the disease in the early stages of development, therefore they are somewhat underestimated, not reflecting the true intensity of caries.

The increase in incidence is determined individually for each person after a certain period equal to several years. The increase in dental caries is the difference between the results of the first and second examination.

Reducing caries - reducing the increase in the intensity of the disease. It is calculated according to the following algorithm: from the index of increase in the intensity of dental caries in the group where preventive measures were taken, the index of increase in the control group is subtracted.

Forms of the disease in children and adults

There are several types of the disease according to the rate of development:

At the same time, acute caries has many varieties. According to the intensity and degree of destruction of dental tissues in adults and children, the following forms of acute caries are distinguished:

compensated;
subcompensated;
decompensated.

Evaluation of caries activity according to the WHO methodology is complex, it should be explained in an increasingly understandable language. The compensated variety of acute caries is characterized by slow development. The patient's dental tissues are subjected to minor destruction, which does not bring discomfort.

The subcompensated form of caries is characterized by an average flow rate. This form of the disease is more active than the previous one, but sometimes the disease can go unnoticed.

Decompensated - the most dangerous type of acute form of the disease, it is often called blooming or multiple. Dental tissues are destroyed in the shortest possible time, after a month they can decompose completely. Usually several chewing elements are affected at once. The decompensated form of caries is characterized by a strong destruction of internal dental tissues.

Assessment of the prevalence of caries

For an objective assessment of the prevalence of the disease, all cases of the disease are taken into account, starting from childhood. To date, WHO statistics are as follows:

in preschool children, the prevalence is about 86%;
in schoolchildren, the prevalence of dental caries reaches 84%;
in adults it reaches almost 100%.

Disease intensity

To assess the intensity of caries, the KPU index is important - the sum of carious, filled and extracted teeth in one patient. Each letter of the abbreviation corresponds to the status of the chewing element. To evaluate several people, the average KPU index is divided by the number of subjects. At present, it is about 7 USD.

It is difficult to assess the intensity of caries on the WHO scale, since there are indicators exclusively for people aged 12 and 35-40 years old. However, according to a rough estimate, today, both among adults and among children, caries prevalence rates reach almost 100%.

Intensity Gain

Growth data are calculated individually. WHO recommends assessing the condition of the teeth for the intensity of caries in accordance with the following requirements:

3 years - assessment of milk teeth;
6 years - the first indigenous;
from the age of 12 - permanent teeth.

In children, the increase in the intensity of caries is determined at intervals of one year. Adults are five to ten years old.

Method for determining reduction

Reduction - a decrease in the increase in the intensity of caries. The method for determining reduction is as follows: a group of people is created who have preventive measures (for example, enamel fluoridation) and a control group.

Then, after some time, the reduction index is calculated. To determine it, the growth index in the control group, where the subjects did not change their habits, is subtracted from the index of the increase in the intensity of the disease in the group where preventive measures were regularly taken.

Clinical examination according to the degree of caries activity

Patients under dispensary observation are divided into 4 categories according to the degree of caries activity in order to increase efficiency:

almost healthy;
with a compensated form of caries;
with subcompensated caries;
with decompensated caries.

1 subgroup undergoes a scheduled preventive examination once a year. 2 subgroup is observed every six months. 3 subgroup - once every 3-4 months, 4 - once a month.

With the help of clinical examination, the number of removed molars and cases of complications is reduced by dividing patients into groups. This method of medical examination helps to reduce the need for the treatment of acute caries by 43.5 percent. Also, with the division according to the degree of disease activity, the number of fillings installed and the volume of work of the dentist decrease.

The main indicators of dental caries (prevalence, intensity, growth and reduction of caries growth).

Used in dental examinations additional methods examinations. Conventionally, they can be divided into three groups:

1. X-ray methods of research.

2. Physical diagnostic methods.

3. Laboratory research methods.

To first group include the following methods:

1) intraoral contact radiography (film, digital): interproximal (bite), parallel, isometric (angular);

2) extraoral radiography: panoramic, teleroentgenography (TRG), etc.;

3) tomography;

4) radiography using contrast agents.

In second group includes electroodontometry, rheography, transillumination method, luminescent diagnostics, capillaroscopy, etc.

Third group includes cytological, histological, microbiological research methods, biochemical parameters of blood, urine and saliva, immunological diagnostic methods.

Thus, during a dental examination, common risk factors for the development of dental diseases can be identified. When collecting anamnesis, it should be clarified whether there were toxicoses in the first and second half of pregnancy in the mother, the nature of feeding the child in the first year of life, the presence of endocrine pathology, diseases of the gastrointestinal tract, the cardiovascular system, the frequency of colds, etc. When conducting an objective examination, local factors important for the development of caries should be assessed: poor oral health, increased saliva viscosity, consumption of foods high in sugar, crowding of teeth.

It should be remembered that pathological processes in the periodontium, arising under the influence of various factors, in children occur in morphologically and functionally immature tissues. The periodontium in children is especially vulnerable to even minor irritants. Unsatisfactory hygienic condition of the oral cavity - plaque, tartar; local irritating factors - carious cavities, defective fillings and orthodontic appliances; violation of occlusion and malocclusion; violation of nasal breathing; anomalies of attachment and structure of the soft tissues of the oral cavity (vestibule, frenulum of the lips and tongue); functional overload or underload of the masticatory apparatus are the main risk factors for the development of periodontal diseases in childhood.

Early detection and elimination of risk factors for major dental diseases prevents their development in children and adults.

Tests α=2

1. The methodology for examining a dental patient includes two main sections:

A. Survey and objective research

B. examination and laboratory examination

C. examination and physiotherapeutic examination

D. Interview and Lab

E. examination and biochemical examination

2. From what departments do intraoral examination of a dental patient begin?

A. oral vestibule

B. dentition

C. tongue mucosa

D. buccal mucosa

E. soft palate mucosa

3. Specify the depth of the vestibule of the oral cavity in the norm?

A. 9 to 16mm

B. 3 to 6mm

C. 1 to 5mm

D. 10 to 15mm

E. 5 to 10mm

4. In what position should the patient's head be when examining the submandibular lymph nodes?

A. turned to the right

B. tilted forward

C. turned to the left

D. folded back

E. folded back and to the side

5. Specify which type of bite is physiological?

A. orthognathic

B. deep

C. progenic

D. prognathic

E. cross

6. What is the name of the method of examining a tooth in which it is lightly tapped with a dental instrument?

A. Probing

B. percussion

C. palpation

D. luxation

E. protrusion

7. What pathological process corresponds to the entry in the dental formula with the symbol "Pt"?

A. caries

B. pulpitis

C. periodontitis

D. periodontitis

E. stomatitis

8. What is the name of the stage of examination of the patient during which, according to the patient, passport data, past diseases, complaints, the occurrence, development of a real disease, etc. are recorded?

A. paraclinical study

B. clinical study

C. follow-up recording

D. patient registration

E. history taking

9. What method is used to examine the lymph nodes during examination?

A. percussion

B. palpation

C. thermometry

D. radiography

E. staining

10. International digital designation system for permanent teeth:

85 84 83 82 81|71 72 73 74 75

V IV III II I|I II III IV V

8 7 6 5 4 3 2 1|1 2 3 4 5 6 7 8

E. All answers are correct.

11. International digital system of milk teeth:

18 17 16 15 14 13 12 11|21 22 23 24 25 26 27 28

48 47 46 45 44 43 42 41|31 32 33 34 35 36 37 38

55 54 53 52 51|61 62 63 64 65

85 84 83 82 81|71 72 73 74 75

V IV III II I|I II III IV V

8 7 6 5 4 3 2 1|1 2 3 4 5 6 7 8

E. All answers are correct.

12. Graphic-digital system for designating permanent teeth:

V IV III II I|I II III IV V

8 7 6 5 4 3 2 1|1 2 3 4 5 6 7 8

18 17 16 15 14 13 12 11|21 22 23 24 25 26 27 28

48 47 46 45 44 43 42 41|31 32 33 34 35 36 37 38

55 54 53 52 51|61 62 63 64 65

85 84 83 82 81|71 72 73 74 75

E. All answers are correct.

13. Graphic-digital system for designating milk teeth:

V IV III II I|I II III IV V

8 7 6 5 4 3 2 1|1 2 3 4 5 6 7 8

18 17 16 15 14 13 12 11|21 22 23 24 25 26 27 28

48 47 46 45 44 43 42 41|31 32 33 34 35 36 37 38

55 54 53 52 51|61 62 63 64 65

85 84 83 82 81|71 72 73 74 75

E. all answers are correct

14. During an external examination of the patient, it is possible to assess:

A. oral vestibule

B. condition of the temporomandibular joint

C. body temperature

D. frenulum of the tongue

E. psycho-emotional state

15. What dental instrument is used to determine the mobility of teeth?

A. Mirrors

B. tweezers

D. Excavator

E. Spatula

Control questions (α=2).

1. What is the purpose of a dental examination?

2. List the main methods of dental examination.

3. How to collect an anamnesis correctly?

4. How to identify bad habits in a child? Why is it important?

5. What are the main complaints of dental patients?

6. What is the sequence of the dental examination?

7. What instruments are used for clinical dental examination of a patient?

8. What is the purpose of external examination of the patient?

9. In what sequence and how is palpation of the lymph nodes in the maxillofacial region performed?

10. How to determine deviations in the state of the TMJ in dental diseases?

11. How and by what criteria is the vestibule of the oral cavity evaluated? What types of oral vestibule do you know?

12. What anomalies of the frenulum of the lips are detected during a dental examination?

13. How is the condition of the oral mucosa and tongue assessed?

14. How to determine the state of bite? What types of bite do you know?

15. How and in what sequence are dental examinations carried out?

16. What is the purpose of probing, percussion and palpation during a dental examination of a patient?

17. What methods of additional examination of the patient exist?

18. What risk factors for the development of major dental diseases should be identified during an objective examination of the patient?

The main indicators of dental caries (prevalence, intensity, growth and reduction of caries growth).

Planning of medical and preventive care, development of preventive programs and evaluation of their effectiveness are impossible without studying and monitoring dental morbidity in the population. The incidence of dental caries is assessed on the basis of determining such indicators as the prevalence and intensity of caries (indices kp, KPU, kp + KPU of teeth, KPP, KPUp, KPUp + kpp), growth and reduction of the growth of dental caries.

The main indicators (indices) of the carious process are recommended by WHO.

Prevalence of caries- an indicator determined by the ratio of the number of children with caries (carious, filled and extracted teeth) to the total number of examined (calculated as a percentage):

In determining this indicator, the number of children with caries includes children who need and do not need (ie, those with fillings) caries treatment.

For example: when examining 1100 children, 870 had carious teeth in the oral cavity. The prevalence of caries among the surveyed contingent is:

(870/1100) x 100%= 79,1 %

To compare the prevalence of caries in different regions of the same country or different countries, WHO proposed to estimate the prevalence of this disease among 12-year-old children.

Intensity of caries characterized by the degree of damage to the teeth by caries and is determined by the average value of the indexes KPU, kp. KPU + kp of teeth and cavities.

The intensity index reflects the number of affected teeth and cavities. The intensity indicator reflects the degree of damage to the teeth by caries in one child.

In a permanent dentition, the index KPU or KPUp is calculated, in a removable dentition - KPU + kp or KPUp + kpp, in a temporary bite - kp or kpp, where:

K - carious permanent teeth;

P - sealed permanent teeth;

Y - removed permanent teeth;

j - carious temporary teeth;

n - sealed temporary teeth.

When determining caries indices, early (initial) forms of dental caries in the form of foci of enamel demineralization (white or pigmented spots) are not taken into account.

Removed temporary teeth are taken into account in exceptional cases when, due to age, the change of temporary teeth by permanent ones has not begun and the child has the III degree of caries activity (decompensated form).

KPU index(teeth) is the sum of carious, filled and removed permanent teeth in one child. The KPU index is calculated for 28 teeth (for a number of reasons, wisdom teeth are not taken into account). The KPU index consists of the following components: caries (C), filling (P) and removal (U). Thus, the incidence rate, combining K + P + U, can give an idea of the quantitative side of carious disease. In order to more accurately assess dental health, the indicated symbols register not only the condition of the teeth (KPU 3, where s is the tooth), but also individual surfaces of the teeth (KPU P, where n is the surface). To register the KPU P index, 5 surfaces are distinguished on each chewing tooth (occlusal, buccal, lingual, mesial, distal), on the frontal teeth - only 4 surfaces (the same without occlusal). Since the condition of the surfaces of wisdom teeth is not taken into account, the maximum value of KPU P is 128, the maximum value of KPU 3 is 28.

KPUp index(surfaces) - this is the sum of carious, filled surfaces and removed permanent teeth in one child. KPUp can be equal to KPU or more than it (since one tooth can have several cavities or fillings on different surfaces of the tooth).

kp index(teeth) - this is the sum of carious and filled temporary teeth in one child. Removed temporary teeth are not taken into account. They can be taken into account only in some cases, when temporary teeth are removed very early (more than 2 years before the physiological change).

Gearbox index(surfaces) - this is the sum of carious and filled surfaces in temporary teeth of one child, kp can be greater than or equal to kp.

In a temporary occlusion, the kp of teeth can take values in the range from 0 to 20, the values of kp are from 0 to 88.

KPU+kp index(teeth) is the sum of carious and filled permanent and temporary teeth, as well as removed permanent teeth in one child.

KPUp+kpp index(surfaces) - this is the sum of removed permanent teeth, carious and filled surfaces of temporary and permanent teeth in one child KPUp + kpp can be greater than or equal to KPU + kp.

When determining the index KPU (kp) of teeth, a tooth that has both a carious cavity and a filling is considered carious.

For example: in a 12-year-old child, a dental examination revealed 3 carious, 5 filled and 1 extracted teeth. The CPU index is: 3+5+1=9.

The intensity of the carious process is not constant. It varies depending on the age of the child, the type of bite, diseases, etc.

To determine the average intensity of caries in the group of examined persons, it is first necessary to determine the individual indicators of the intensity of caries, sum them up and divide by the number of examined.

The intensity of caries in a group of children is calculated using the following formula:

For example: 10 people were examined. The intensity of caries in each individual of them was: 6,8,9,5,5,7,10,6,0,3 (one child did not have caries). Thus, on average, the intensity of caries in the examined group is:

(6 + 8 + 9 + 5 + 5 + 7 + 10 + 6 + 0 + 3)/9 = 6,56

WHO proposes the following assessment criteria for the intensity of dental caries according to the KPU index for 2 key groups: 12 years and 35-44 years.

The KPU index is an informative indicator both in general and for individual components. The average number of carious teeth identified when determining the index makes it possible to plan the volume of medical work, the number of filled teeth - to assess the quality of dental sanitation, and the number of teeth removed - the required amount of orthopedic care.

Rice. Clinical condition of the dentition of the upper and lower jaws. Multiple restorations are visible, several teeth with caries, one tooth is missing.

Cavity caries indices are more informative in determining the level of caries intensity and are used mainly in assessing the effectiveness of preventive measures.

Rice. The status of the patient, described by the indexes KPU, (green) and KPU P (yellow).

To assess the effectiveness of caries prevention measures, indicators of the increase in intensity and reduction in the growth of caries are used.

Intensity Gain caries (morbidity) is defined as the average number of teeth in which new carious cavities have appeared over a certain period, for example, per year per child with caries.

The increase in the intensity of caries is determined by the difference between the KPU indices after a certain period of observation, for example, one year, several years. As a rule, the increase in caries is calculated after a year, and in persons with an increased risk of caries (patients with pathology of internal organs, an active course of the carious process and etc.) - after 6 months.

For example: at the age of 4, the child has an index kp = 2, kpp = 3, at 5 years old - kp = 4, kpp = 6.

In this case, the increase in the intensity of caries of temporal teeth is equal to kp = 2, according to kp = 3.

In the period of mixed dentition due to the removal of temporary teeth, the growth rate of caries can be expressed as a negative number.

For example: at 9 years old KPU + kp = 3, Kpp + kpp = 4; at 10 years KPU + kp = 2, KPUp + kpp = 3.

The increase in the intensity of caries after a year, therefore, is -1, cavities -1.

With preventive measures, the growth of caries slows down or is not determined at all.

To assess the effectiveness of preventive measures allows the indicator caries growth reduction(in percentages).

Calculation of the reduction of caries growth is carried out according to the formula, based on the absolute values of the increase in the indicators of the KPU of teeth (surfaces) in the control and main (experimental) groups (E.B. Sakharova, 1984):

((Mk-Md)/Mk) x 100%

Mk- the average value of the increase in the indicator in the control group;

Md- the average value of the increase in the indicator in the experimental group.

For example: in the control group, an increase in the intensity of caries after one year was equal to 1.5, which is taken as 100%.

In the group of children who underwent preventive measures, the increase in the intensity of caries after one year was lower - 1.0, which is 66.6% in relation to 1.5.

Hence, the reduction of caries in this case: 100% - 66.6% = 33.4%.

Tests α=2

1. What indicator is determined by the ratio of the number of children with caries to the total number of those examined?

A. intensity of caries

B. incidence of caries

C. prevalence of caries

E. reduction of caries growth

2. What indicator characterizes the degree of tooth decay by caries?

A. intensity of caries

B. incidence of caries

C. prevalence of caries

D. increase in the intensity of caries

E. reduction of caries growth

3. What indicator is defined as the average number of teeth in which new carious cavities have appeared over a certain period?

A. intensity of caries

B. susceptibility to caries

C. prevalence of caries

D. increase in the intensity of caries

E. reduction of caries growth

4. How is the dental caries score recorded for temporary occlusion?

5. How is the index of dental caries intensity recorded for mixed dentition?

6. How is dental caries intensity recorded for permanent occlusion?

7. How is the indicator of the intensity of caries of cavities recorded in a temporary occlusion?

8. How is the intensity of caries of cavities recorded in mixed dentition?

B. KPUp+kpp

9. How is the intensity of caries of cavities recorded in the permanent dentition?

10. What level of intensity of dental caries according to WHO among 12-year-old children corresponds to a value of 1.2-2.6?

A. very low

C. medium

D. high

E. very tall

11. What level of intensity of dental caries according to WHO among 12-year-old children corresponds to a value of 4.5-6.5?

A. very low

C. medium

D. high

E. very tall

12. What level of intensity of dental caries according to WHO among 12-year-old children corresponds to a value of 0.0-1.1?

A. very low

C. medium

D. high

E. very tall

13. What level of intensity of dental caries according to WHO among 12-year-old children corresponds to a value of 2.7-4.4?

A. very low

C. medium

D. high

E. very tall

14. What level of intensity of dental caries according to WHO among 12-year-old children corresponds to a value of 6.6 and above?

A. very low

C. medium

D. high

E. very tall

15. What is the WHO prevalence of dental caries among 12-year-old children that corresponds to a value of 0-30%?

A. very low

C. medium

D. high

E. very tall

16. What is the WHO prevalence of dental caries among 12-year-old children corresponding to a value of 31-80%?

A. very low

C. medium

D. high

E. very tall

17. What is the WHO prevalence of dental caries among 12-year-old children that is 81-100%?

A. very low

C. medium

D. high

E. very tall

Control questions (α=2).

value of IGR-U

1: 0,0-1,2 - good

1,3-3,0 - satisfactory

3,1-6,0 - bad i

b) Values indicators of plaque or tartar: i
0,0-0,6 - good I
0,7-1 ,8 - satisfactory

1,9-3,0 - bad

Oral hygiene performance index (PHP) (Podsliadley, Haley, 19o8)

For quantification of plaque stain b teeth:

16, 26, 11, 31 - vestibular surfaces; 36. 46 - lingual surfaces

In the absence of an index tooth, an adjacent one is examined, within the same group of teeth. Artificial crowns and parts of fixed prostheses are examined in the same way as forelocks.

The surface of each tooth is conditionally divided into 5 sections (Fig. ! 11.

Codes and criteria for assessing plaque

- no staining
- staining detected

Index calculation

A. Determine the code for each tooth by adding the codes for each area.

D

1 - medial

- mid-occlusion
- central
- mid-cervical

Example of code calculation for a single tooth

On fig. 12 shows examples for calculating plaque codes for

individual teeth.

A- staining was detected in one area-

Flax diet.

Blitz code is 1

B - staining was detected in three areas - medial, distal and mid-cervical.

The raid code is 1 + 1 + 1=3

C - staining was detected in 4 areas - medial, distal, mid-cervical and central.

The raid code is 1 + 1 + 1 + 1-4

Fig.12. Examples of staining when determining the PHP index

B. Sum up the codes for all examined teeth and divide the resulting sum by the number of teeth.

^ Calculation formula;

Sum of codes of all teeth.-.

PHP=-

Number of teeth examined

Index interpretation:
Index value Hygiene level

Oh excellent

0.1-0.6 good

0.7-1.6 satisfactory

V over 1.7 unsatisfactory

^ TO PREVALENCE ASSESSMENT

TO AND INTENSITY OF DENTAL CARIES

^B 1. Criteria for assessing carious lesions

^B Prevalence of dental caries- is the ratio of the number of persons^ShWaying at least one of the featuresmanifestations of dental caries (carious, or extracted teeth)to the total number of examined, expressed in Kennoe inpercent.

To determine the prevalence, the number of people who have dental caries (except for focal demineralization) is divided by the total number of people examined in this group and the result is multiplied by 100.

Example: In the group of examined out of 100 people, 80 had carious, filled or extracted teeth. Prevalence calculation:

8Q x 100% - 80% 100

Thus, the prevalence of dental caries in this group is 80%.

In order to estimate the prevalence of dental caries in the group examined or to compare the value of this indicator in different regions, the WHO evaluation criteria for 12-year-old children are used:

^ Prevalence rates of caries
Low - 0-30%

Medium 3! -80%

High - 81-100%

The intensity of dental caries- this is the sum of clinical signs of carious lesions [carious, filled and extracted teeth), calculated individually for one or a group of patients.

To assess the intensity of caries of temporary (milk) forelocks, the following indices are used:

kpu index (h) -

This is the sum of teeth affected by untreated caries (component "k"), filled (component "p") and removed (component "y") in one examined child.

Note: when determining the number of extracted teeth, only those that are removed prematurely, before their physiological resorption, are considered.

^ Calculation example:

V child 4 years old revealed:

1 tooth with untreated caries, 1 filled tooth and 1 extracted tooth.

kpu index is: ! + 1 + 1 = 3

kpu index ("J-

This is the sum of surfaces affected by untreated caries, filled and extracted teeth in one examined child.

Note: when determining the number of surfaces of extracted teeth, only teeth that are removed prematurely are considered, to their physiological

^ Calculation example:

Examination of a 4-year-old child revealed 1 tooth with a carious lesion on the vestibular surface, 1 tooth with a filling located on the contact and chewing surfaces, 1 tooth (55) was removed after

Index kpu (n) is equal to: 1 +2+5 = 8

The average value of the kpu(h) and kpu(p) indices in the group of examined children To calculate this indicator, determine the value of the kpu(z) or kpu(p) index for each examined child, add up all the values and divide the resulting amount by the number of people in the group of examined children.

To assess the intensity of caries in permanent teeth, the following are used:

Index KPU (h) -

The sum of carious (component "K"), sealed (component "P") and removed (component "U") teeth in one examined.

^ KPU index (nj -

The sum of all tooth surfaces diagnosed with caries and filled in one individual.

If a tooth is removed, then in this index it is considered as 4 or 5 surfaces, depending on group affiliation.

Note: When determining these indices, early (initial) forms of dental caries in the form of foci of demineralization (white or pigmented) are not taken into account.

The average value of the KPU (h) and KPU (p) indices in group of examined To calculate this indicator, determine the value of the index CPU(h) or KPU (p) for each examined, add up all the values and divide the resulting amount by the number person in a group surveyed.

Calculation example:

When examining a group of adolescents of 5 people, the individual values of the KPU index were:

The sum of the individual values of the KPU ~ 17. " ■ KPU avg. = -12- - 3,4

Assessment of the intensity of dental caries at the population level

To compare the intensity of dental caries in different regions, the average values of the KPU index proposed by WHO for two key age groups - 12-year-olds and 35-44-year-olds are used.

There are 5 levels of intensity of dental caries:

0-1,1	^ VERY LOW	0,2-1,5
1,2-2,6	SHORT	1,6-6,2
2,7-4,4	MIDDLE	6,3-12,7
4,5-6,5	TALL	12,8-16,2
6.6 and up	^ VERY HIGH	16.3 and up

2. Methods for diagnosing initial caries

visual method

This method is most easily performed in a dental office and is effective for identifying foci of enamel demineralization in the form of a white spot.

The examined tooth is cleaned of plaque, isolated from saliva and the surface is dried with air. Visually determine the size of the foci of demineralization. The surface of the enamel in the area of the white spot is rough, but dense.

^ Method of vital staining of enamel

With its help, it is possible not only to identify focal demineralization of the enamel, but also to judge the degree of damage to the enamel.

The staining method is based on the fact of increasing the permeability of demineralized enamel for dye (2% methylene blue aqueous solution).

The tooth is cleaned of plaque, isolated from saliva with cotton rolls and dried. A dye is applied to the surface of the tooth for 3 minutes, after which the swab is removed and the excess dye is washed off.

Enamel staining is assessed either using a special 10-point scale with different shades of blue, or visually, subdividing the intensity of staining into low, medium and high.

For diagnostic purposes, a single staining of the enamel is sufficient. To monitor the effectiveness of the treatment, re-staining of the enamel after certain periods of time should be carried out.

The method of vital enamel staining is convenient for the differential diagnosis of initial caries from non-carious lesions of the hard tissues of the tooth, such as fluorosis and enamel hypoplasia, in which staining does not occur. This method also serves to determine the need for a repeated course of remineralizing therapy.

^ Instrumental Methods

Diagnosis using the devicePluruflex effective for identifying hidden spots of carious origin and a more accurate definition of the boundaries of demineralization foci. For its implementation, a source of ultraviolet radiation (Pluraflex device) is required.

The tooth is cleaned of plaque and dried. Intact enamel under the action of ultraviolet rays emits a bluish luminescent glow. In the presence of a carious spot, the luminescence is quenched against the background of the normal glow of the surrounding unaffected enamel.

^ Diagnosis using the device "Dignodent". developed German-

Tjgp fi by KaVo, is used to detect initial caries in those

^ In dachas, when it is difficult to determine visually (for example, foci of demin-

^^ Illizations are located on the contact surfaces of the teeth or in the area

Fissure of chewing surface).

The principle of its operation is that a laser diode creates pulsed light waves of a certain length that fall on the surface of the tooth. Pathologically altered tooth tissues reflect light waves of a different wavelength, in contrast to intact enamel. The length of the reflected waves is analyzed by the corresponding electronics of the device, and when a demineralization center is detected, an audible signal appears.

3. Determining the risk of caries

^ Colorimetric test

The patient rinses the mouth with 1% glucose solution and then with 0.1% methylene red solution, which stains plaque yellow. In those areas where the pH of plaque is below 5.0, after a few seconds, the yellow color changes to red. In these areas, enamel demineralization is most likely to occur.

^ Determination of the pH of the oral fluid and plaque carried out using an electronic pH meter.

For this, mixed saliva is collected on an empty stomach in the morning in an amount of 20 ml. After a three-time study of the same sample, an average is established. Oral fluid pH can also be determined directly in the patient's mouth by placing the instrument's electrode in the sublingual region.

To determine the pH of plaque, the tooth is isolated from saliva using cotton rolls and dried with air. 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.

^ Determination of saliva viscosity carried out using an Oswald viscometer on an empty stomach or 3 hours after a meal. Examine the viscosity three times. An increase in the viscosity of saliva by 2 times or more (the norm is 4.16 units) indicates the susceptibility of enamel to caries.

^ PREVALENCE ASSESSMENT

AND INTENSITY OF DAMAGE

PERIODONTAL TISSUE

CPITN and CPI indices

To assess the prevalence and intensity of periodontal disease, WHO recommended indexes of need for periodontal disease treatment - CPITN and communal periodontal index -CPI are used.

The CPI index, unlike the CPITN index, does not include the “need for treatment” section, since when conducting a mass epidemiological survey of the population, an assessment of the need for dental care is not always necessary. Otherwise, when determining the CPI index, the same tools, methodology, codes and evaluation criteria are used as when determining the CPITN.

To determine the CPITN or CPI indices, the dentition is conditionally divided into 6 parts (sextants), including the following teeth:

17-14	13-23	24-27
47-44	43-33	37-44

This provides for a periodontal examination in the area of index teeth and an assessment of the most pronounced clinical sign.

A sextant is taken into account if it contains two or more teeth that cannot be removed. If only one tooth remains, then the sextant is scored as excluded.

In the adult population, starting from 20 years and older, periodontium is examined in the area of 10 index teeth:

At this age, the second molars are excluded from the examination, since false pockets can be detected, the formation of which is due to inflammation, and eruption of the tooth.

The examination should be carried out using a periodontal (button) probe, designed specifically for manipulation in the very sensitive soft tissues surrounding the teeth.

The force with which the probe is applied should not exceed 20 grams (this corresponds to painlessly pressing the probe under the thumbnail).

The diameter of the ball at the end of the probe is 0.5 mm. In the end area of the probe there are two marks - 3.5 mm and 5.5 mm, and two additional marks -

The depth of the groove or pocket is determined by placing the probe between the tooth and the gum. The direction of movement of the probe should be in the plane of the tooth axis.

^ Codes and evaluation criteria:

Code 0 - healthy tissues.

Code 1 - bleeding observed during or after probing; bleeding may appear immediately or 10-30 seconds after probing.

Code 2 - tartar or other factors that delay plaque (overhanging edges of fillings, etc.). visible or felt during probing.

Code 3 - periodontal pocket 4-5 mm (gingival margin is in the black area of the probe or the 3.5 mm mark is hidden).

Code 4 - periodontal pocket 6 mm deep or more (with the 5.5 mm mark or black area of the probe hidden in the pocket).

Code X - when only one tooth is present in the sextant or there is not a single tooth (third molars are excluded, except when they are in place of the second molars).

^ Need for treatment periodontal disease in a population or individual patients is carried out taking into account the following criteria and codes:

The code 0 (healthy) or X (deleted) for all 6 sextants means that there is no need to treat this patient.

Col 1 or higher indicates that this patient needs to improve oral hygiene.

The code 2 or higher indicates the need for professional hygiene and the elimination of factors that contribute to the retention of plaque. In addition, the patient needs training in oral hygiene.

The code 3 indicates the need for oral hygiene and curettage, which usually reduces inflammation and reduces pocket depth to values equal to or less than 3 mm.

The code 4 - sextant can sometimes be successfully treated with deep curettage and adequate oral hygiene. In other cases, this treatment does not help, and then complex treatment is required, which includes deep curettage.

By determining the values of the CPITN or CPI indices, it is possible to calculate the prevalence and intensity of periodontal diseases.

■ ^ The prevalence of periodontal disease

To calculate the prevalence, the number of individuals who have any signs of periodontal disease (codes 1, 2, 3, 4 of the CPITN or CPI index) is divided by the total number of patients examined in this group and multiplied by 100.

^ Calculation example;

In a group of 20 examined: 2 had no signs of damage, 7 had bleeding gums, 5 had tartar, 4 had periodontal pockets 4-5 mm deep, 2 had periodontal pockets 6 mm or more deep.

The prevalence of periodontal diseases in this group; .

7 + 5 + 4 + 2= 18

18: 20 x 100%-90%

In addition to this, it is possible to determine the prevalence of individual signs of periodontal disease.

8 in the example above:

A) prevalence of bleeding gums:

7: 20 x 100% - 35% 6) prevalence of tartar:

5: 20 x 100% = 25%

B] the prevalence of periodontal pockets 4-5 mm:

4: 20 x 100% = 20%

D) the prevalence of periodontal pockets 6 mm or more:

2: 20 x 100% = 10%

PRINCIPLES AND METHODS OF DENTAL EXAMINATION

The intensity of periodontal disease

The intensity of periodontal disease in a patient is determined by the sum of sextants with codes 1, 2, 3, 4.

The average intensity of periodontal disease in the group of patients is determined by the sum of sextants with signs of damage, divided by the number of persons in this group.

Calculation example

In the group examined:

patient: 2 sextants with bleeding, 1 ~ with stone, 1st pocket
4-5 mm (total 4 affected sextants);
patient: 1 sextant with bleeding, 3 - with a stone (total 4 affected
patient: 2 sextants with a stone, 1 - with harmon 4-5 mm (3 affected
patient: 4 sextants with bleeding, 1 with a stone (5 affected

For a group: 4 + 4 + 3 + 5= 16 16:4 = 4

Thus, in this group of examined, the average number of sextants with signs of periodontal disease is 4.0.

Assessment of the prevalence and intensity of periodontal disease at the population level

The assessment of the prevalence and intensity of periodontal diseases at the population level in different regions is carried out on the basis of criteria. proposed by WHO for a key age group - 15-year-olds.

The following are the levels of prevalence of individual signs of periodontal disease:

Level	Croy	agility	Tooth	)Y
prevalence		gums	a rock
Short	0	- 50%	0 -	20%
Middle	51	- 80%	21 -	50%
Tall	81	- 100%	51 -	100°/

Criteria for the intensity of signs of periodontal damage at the population level

Level	Bleeding	Dental
intensity	gums	a rock
Short	0.0-0.5 sextants	0.0-1.5 sext;
Middle	0.6 1.5 sextants	1.6-2.5 sext
Tall	> 1.6 sextants	>2.6 sixths]

Loss of epithelial attachment (WHO, 1995)

This index is designed to evaluate the destruction of the periodontal attachment (Fig. 14). It should be noted that obtaining such information during epidemiological dental surveys allows comparison between populations, but does not imply a complete description of attachment loss in an individual patient.

This indicator is registered starting from the age of 15.

Attachment loss is assessed during an epidemiological survey immediately after determining the CPI index. For this purpose, a periodontal (button) probe with marks at the level of 3.5 is used; 5.5; 8.5: II. 5 mm.

Codes and evaluation criteria:

Loss of attachment 0-3 mm (cement-enamel joint,
CES, invisible).
Loss of attachment 4-5 mm (CES is between the zone marks
yes 3.5 and 5.5 mm).
Loss of attachment 6-8 mm ((CES is between the zone marks
yes 5.5 and 8.5 mm).
Loss of attachment 9-11 mm ((CES is between the marks
probe 8.5 and 11.5 mm).
Loss of attachment 12 mm or more (CES is behind the label
probe 11.5 mm).

^ PMA index (Parma, I960)

To assess the severity of gingivitis, the papillary-marginal-alveolar index (PMA) in the modification of Parma (1960) is used.

The condition of the gums for each tooth is assessed after staining with Schiller-Pisarev solution. At the same time, the inflamed areas of the gums become brown due to the presence of glycogen-

Codes and evaluation criteria (Fig.15): 0-no inflammation;

- inflammation of the gingival papilla (P);
- inflammation of the gingival papilla and marginal gingiva (M);
- inflammation of the gingival papilla, marginal and alveolar gums (A).

^ PRINCIPLES AND METHODS OF DENTAL EXAMINATION

I calculate the PMA index!" but the formula: - ,]■

| RMA \u003d CyMMd all ° B x 100%

K 3 x number of teeth

K.- The number of teeth (while maintaining the integrity of the dentition) is taken into account
varies according to age:
W^ 6-11 years - 24 teeth

By 12-14 years - 28 teeth

SCH 15 years and older - 30 teeth ■ ■-.-.

AT, Note: if part of the teeth is missing, then they are divided by the number of teeth present in the

B. "The fury of the mouth of the teeth.

¥ Index interpretation

I, The larger the numerical value of the index, the higher the intensity of gin-

B Index Value Criteria

SC less than 30% - mild severity of gingivitis

K 31-60% - moderate severity

N. 61% and above - severe degree

G Index gingivigaGl (LoeH., Strength1, 1963}

Index Loe H., Silness J. is designed to determine the localization and severity of gingivitis and is used for clinical and epidemiological studies.

When determining the index, the gum is examined in the area of the following teeth:
16 12 24

Assess the condition of the gums in the area of each tooth in 4 areas:

distal;
medial;
in the center of the vestibular;
in the center of the language department.

The study is carried out visually and using a periodontal bulbous probe.

Codes and evaluation criteria (Fig.16): The code 0 - no inflammation

The code 1 - mild inflammation of the gums (slight change in color and structure, no bleeding during probing)

The code 2 - moderate inflammation of the gums (moderate hyperemia, edema and hypertrophy); bleeding on probing

The code 3 - severe inflammation of the gums (severe hyperemia, edema are noted); tendency to spontaneous bleeding.

^ Index calculation:

The average value of the code for each tooth is calculated, then the values for all teeth are summed up and divided by the number of examined teeth.

^ Formulas for calculation:

Sum of points
GI tooth =

Sum GI teeth

GI of an individual = ■

Where n is the number of teeth (usually 6)

Index interpretation:

Index value Criteria

0,1-1,0 mild gingivitis

1.1-2.0 moderate gingivitis
2.1-3.0 severe gingivitis

^ PREVALENCE AND

INTENSITY OF BASIC

DENTAL

DISEASES

PREVALENCE AND INTENSITY
MAIN DENTAL DISEASES

NNEi assistance is carried out on the basis of a study of the stomatological prevalence of the population.

^G Particular attention is paid to the study of the prevalence and |G intensity of the main dental "diseases. W The creation of the World Data Bank of Dental Morbidity-IbGI makes it possible to monitor the level of dental morbidity and NCcinamics and to summarize the results of a survey of the population of different H|>an
^^^ At the same time, the universal indicator of the dental status of the population is the value of the KPU index in 12-year-old children, who are the key age group for assessing the intensity of dental caries at the population level.

Table 1

The value of the KPU index in 12-year-old children in the countries of Europe, America, Asia, Africa and Australia.

Austria		978 997	3,0 1,7	Luxembourg Malta	1990 1985	3,0
Belarus		972 994	3,0 3,8	Netherlands	1985 1992-93	1,7 0,9
Belgium		972 998	3,1 1,6	Norway	1985	3,4 2,1
Bulgaria		993	3,1	Poland	1985	4,4
UK		983	3,1		1992	5,1
	15	96-97	1,1	Portugal	1984	3,8
Hungary		985	5,0		1999	1.5
		996	3,8	Russia	1 989-95	3,7
Germany		989	4,1		1996-98	2,9
		997	1,7	Romania	1986	3,1
Greece		960	3,8		1995	3,4
		993	1.6	Slovenia	1993	2,6
	IS	85-90	2,4		1993	1.8
		978	6,4	Turkmenistan	1985-90	2,6
		2000	1,0	Turkey	1988	2,7
Israel		966 989	2,4 3,0	Uzbekistan	1988-90 2 ?
Italy	979 1996		6,9 2,1	Czech	1987 1993	3, 2,	3 7
Kazakhstan	198S-90		2,1	Switzerland	1964-68	8,0
Kyrgyzstan		973	3,1		1992	1,4
Latvia		993 998	5.84j2	Sweden	1937 1999	7,8 0,9
Lithuania		986	3,6 3,8	Estania	1992	4,

In Russia, caries affects all age groups of the population. As patients age, so does the prevalence of the disease. The intensity of caries is determined by the calculation method. The calculation includes people with a diagnosed disease, the number of teeth or sites of inflammation.

The prevalence of caries can be calculated in numbers using the formula. This value is expressed as a percentage, it is not difficult to determine it if we know the number of patients who have treated or extracted teeth. The figures obtained must be divided by the total number of patients and multiplied by 100%.

There is a concept of the intensity of caries damage in one patient or the intensity index of the KPU, where P is the number of teeth with fillings, and Y is the number of teeth removed.

When calculating the KPU tooth index, we take the index of affected teeth in an individual patient and divide this number by the number of people examined. A sealed tooth with inflammation revealed during examination also refers to carious, and is taken into account.

In children, in addition to permanent ones, there are dairy ones. Therefore, when calculating the KPU intensity index, the sum of temporary and permanent teeth is taken.

Statistics on the frequency and course of caries under certain conditions in different age groups makes it possible to:

To study the etiology and pathogenesis, causes and factors influencing the onset of the disease.
Planning for the prevention of caries in different groups of patients in the future.
Determine the effectiveness of the preventive measures taken.
Planning medical care for different groups of patients in the future.

You can choose the scale of calculation of the intensity index depending on the purpose of the statistics.

The number of patients with caries is also counted because the prevalence of the disease reaches 100% of the adult population. Therefore, qualified specialists are in demand in dentistry, who have begun to apply the latest methods of treatment and diagnostics. Improving the quality of dental care provided also depends on the statistics of the disease.

Data on the course and nature of the disease are stored in the medical record up to 75 years. Thanks to the archive, you can collect information about the health status of people at different ages.

Collection of information and important indicators

When collecting information on caries, several important indicators are taken into account. First of all, pay attention to the age of the patient. Children belong to a separate group of patients because milk teeth are more susceptible to caries compared to permanent ones. Therefore, cases of the disease are observed at an early age. Adult patients are divided into categories of young, adult and elderly.

Internal and external factors also affect the statistics:

Place of residence.
Climatic conditions.
The length of daylight hours.
The composition of drinking water in the region affects the statistics of the disease.

If the patient's diet is not balanced, there is a deficiency of certain vitamins and minerals in the human body. This leads to further tooth decay.

Studies and their statistics

As mentioned above, in our country the prevalence of caries reaches enormous values. This is due to the fact that already at an early age, children fall ill with caries of their milk teeth. Some parents do not consider it necessary to brush milk teeth, as they will be replaced by permanent ones anyway. This is a big mistake.

If, in its place, the same carious permanent tooth will grow. It is important to start teaching oral hygiene to children at an early age. As they grow older, the degree of caries damage to the population only increases, approaching 100% in its values.

By the age of 6, a child with caries may be affected by the first permanent teeth, which can later lead to their loss.

Much attention should be paid not only to treatment, but also to the prevention of caries. The child must:

Brush your teeth twice a day.
After eating, it is advisable to rinse your mouth.
Do not eat a large amount of sweets, from which children's milk teeth deteriorate.
For cleaning use a special thread that eliminates plaque.
A mandatory item is a visit to the dentist at least 2 times a year for timely treatment.
The toothbrush should be changed at least once every 3 months.

Prevalence

The prevalence and intensity of caries increases depending on the age category. In patients at 12 years of age, the disease progresses from 61% to 96%. In older age categories, caries manifests itself in 100% of cases. All Russians suffer from damage to tooth enamel.

Studies show that the coating is damaged more often on the upper teeth. The disease occurs in people, regardless of age.

According to the indicators of the intensity of carious formations, the following classification is given:

Short – 0-30%.
Middle – 31-80%.
Tall – 81-100%.

Changes in the prevalence of caries in the world over a twelve-year period:

To determine the intensity of caries, the following indicators are used:

The intensity of inflammation of temporary milk teeth:

Index kp (h) corresponds to the sum of teeth with damaged enamel and fillings installed by one dentist.

Index kp (n)- set of points of inflammation.

To determine the average index kp(s) and kp(p) among several subjects, you will have to find out the individual indicators for each patient, summarize all the data and divide the result by all participants in the group.

Intensity of caries of molars:

KPU indicator (h)- a set of teeth with damaged enamel, sealed at the dentist.

KPU index (n)- the sum of all damaged places with a carious formation or filling. If the tooth was pulled out, in this classification it is considered as 5 surfaces.

When calculating such indices, the first stages of caries, light spots, are not taken into account.

To determine the average number for the above indices for a group, you should find the sum of personal indices and divide it by the number of people examined in this group.

Analysis of the intensity of caries in the population. To compare indicators between regions or states, average values of the KPU index are used.

Epidemiological indicators

Cases of caries incidence during examinations of citizens should be taken into account by age categories. This is due to a different tendency to the appearance of the disease in children and the presence of temporary teeth in them. They should also be taken into account in adults. According to WHO recommendations, adults are divided into several age groups.

The prevalence and intensity of caries in the population depends on a number of factors. Geographical factors are considered significant: climate, mineral content in the soil and drinking water, and an indicator of solar activity.

Diet problems are the main cause of caries formation. Usually the diet contains a lot of refined components with carbohydrates. During the heat treatment of food, a large amount of substances necessary for the body is lost. An imbalance in nutrition leads to a lack of nutrients in the body, weakening the immune system.

The importance of rational nutrition is confirmed by data from epidemiological, clinical and experimental studies. The prevalence of caries depends on the age of the person, which is associated with a different number of teeth in children and adults and the tendency of tissues to caries, temporary teeth are more easily affected than permanent ones. This is taken into account in the study.

In children, a rather low KPU + kp index can be regarded as an indicator of an intense carious process due to premature removal of milk teeth. Cases of the prevailing number of patients with caries among men or women have not been recorded.

In a separate life period, for example, during pregnancy, women are more prone to caries, and the number of affected teeth may increase.

General condition of the body

Past and concomitant diseases affect the susceptibility of teeth to caries. Cases of the disease are often recorded in children who have suffered infectious disorders, have problems with the functioning of internal organs. The state of the immune system also affects the development of carious processes..

They are one of the important factors in the occurrence of caries. Regular use of modern prophylactic and hygienic means is an effective method of preventing dental caries.

Uneven cleansing leads to an increase in the incidence of caries. This disease affects teeth, the crowns of which have a complex anatomical shape, a large number of fissures, pits, etc. According to the frequency of distribution on individual teeth, it can be distributed as follows:

first molars;
second and third molars;
premolars;
upper incisors;
lower incisors;
fangs.

The analysis of the CPP index of cavities makes it possible to identify the surfaces of the teeth that are more prone to destruction. In permanent teeth, caries appears at the points of contact between the teeth and in the cervical areas.

Caries is also characterized by symmetrical lesions of the teeth. This is due to the peculiarities of their anatomical design. Susceptibility is affected by damage to hard tissues, often resulting from other disorders, malfunctions of the body, etc.

Method for defining reduction

Reduction means a reduction in the intensity of caries. For a certain group of patients, preventive and control measures are taken. Teeth fluoridation procedures are often used. After some time, the level of reduction is determined.

To do this, the increase in the number of cases in the study group must be subtracted from the increase in the number of cases in the group in which patients adhered to old bad habits.

In the presence of numerous carious formations and complications, sanitation of the oral cavity in a young child often has to be performed, guided by Tokarev's manual.

Such treatment does not eliminate the causes of the onset of the disease, so often babies have to re-sanitize. Therefore, it is necessary to develop an appropriate algorithm for the treatment and prevention of dental caries in young children.

Clinical examination

Patients undergoing treatment in dispensaries are divided into 4 subcategories according to the level of spread of carious formations:

Nearly full teeth.
Light carious process.
Subcompensated caries.
decompensated disorder.

For the 1st subgroup, a scheduled annual inspection is carried out. The 2nd category of patients is examined every six months. 3rd visits the dentist 1 time in 3-4 months. 4th comes to the dentist every month.

Early age means difficulty. Today, dentists use the silvering method instead of traditional cleaning with a drill, since when treating children, doctors face such problems: increased salivation, frequent gag reflex, small mouth volume.

Children quickly get tired and cannot sit in the dental chair for a long time without moving. The silvering method has a significant number of disadvantages and is not used in a number of Western countries.