Multiple caries code according to ICD 10. Classification of caries. Requirements for outpatient drug care

Dental caries. Definition, classification, assessment of the intensity and prevalence of caries, treatment methods.

Question 1. Definition of caries.

CARIES is a pathological process in the hard tissues of the tooth that occurs after teething and consists of focal demineralization of the enamel with subsequent formation of a cavity.

The main reasons for the development of dental caries.

Presence of dental plaque

Consuming large amounts of easily fermentable carbohydrates

Factors contributing to the development of dental caries:

acidic saliva reaction

crowded teeth

low concentration minerals(fluoride) in enamel

presence in the oral cavity additional conditions for plaque retention (braces, orthopedic structures)

hyposalivation

Question 2. Classification of caries according to MMSI.

The MMSI classification of caries was developed taking into account the depth of the carious cavity:

1. Caries in the spot stage (MACULACARIOSA) – focal demineralization of enamel, without cavity formation:

White spot– indicates an active carious process

pigmented spot - indicates some stabilization of the process.

2. Superficial caries (CARIESSUPERFICIALIS) – carious cavity is localized within the enamel

3. Average caries (CARIESMEDIA) – the carious cavity is localized within the dentin, slightly deeper than the enamel-dentin border.

4. Deep caries (CARIESPROFUNDA) - the carious cavity is localized in dentin and predentin (near the pulp).

Question 3. International classification caries according to WHO (from the International Classification of Diseases, 10th revision)

Initial caries(chalk spot stage).

Enamel caries.

Dentin caries.

Cement caries.

Suspended caries.

THE RELATIONSHIP OF THESE TWO CLASSIFICATIONS:


1. Caries in the spot stage White spot pigmented spot	Initial caries
1. Caries in the spot stage White spot pigmented spot	Suspended caries
2. Superficial caries	Enamel caries
3. Average caries	Dentin caries
4. Deep caries	Corresponds to the nosological unit “Initial pulpitis - Pulp hyperemia”, because accompanied by initial changes in the dental pulp.
	Cement caries

Question 4. Classification carious cavities Black.

Black class	Localization of the carious cavity
	Chewing surfaces of molars and premolars, blind fossae of molars and incisors.
	Contact surfaces of molars and premolars.
	Contact surfaces of incisors and canines without disturbing the cutting edge.
	Contact surfaces of incisors and canines with violation of the cutting edge.
	Cervical areas of all groups of teeth (on lingual and vestibular surfaces).
	Cavities located on the tops of the cusps of molars and premolars, on the cutting edge of the incisors.

Question 5. Diagnosis of dental caries.

Carious stain - when dried, a loss of enamel shine is detected; for differential diagnosis with non-carious lesions, vital staining of the enamel is used to identify focal demineralization. METHYLENE BLUE IS USED, AS WELL AS SPECIAL SOLUTIONS – “CARIES MARKERS”.

Carious cavities are detected by probing

With the help of X-ray therapy, carious cavities on contact surfaces are detected, as well as caries under fillings.

Question 6. Assessment of the prevalence of dental caries:

The Dental Caries Prevalence Index is used to estimate the prevalence of dental caries. The index is calculated as follows:

Question 7. Assessment of the intensity of caries:

The intensity of caries is assessed using the KPU index:

For each patient, the number of carious, filled and extracted teeth is counted, then the results are summed up and divided by the number of patients examined.

In some cases (especially in children), the KPP index is used - the sum of filled and carious surfaces (the extracted tooth is counted as 5 surfaces).

The KPU index allows you to assess not only the intensity of caries, but also the level of dental care: if components K and U predominate, then the level of dental care should be considered unsatisfactory, if component P predominates, it should be considered good.

The main groups of the survey are 12-year-old children, 35-44 years old.

(for 12 years old)

very low level of caries intensity 0-1.1

low level of caries intensity 1.2-2.6;

average level of caries intensity 2.7-4.4;

high level of caries intensity 4.5-6.5;

very high level of caries intensity 6.6-7.4;

Question 8. Methods for treating caries:

non-invasive (remineralizing therapy)

invasive (preparation followed by filling).

Remineralization therapy is most effective in the presence of a white carious spot. It is carried out as follows: professional hygiene, application of calcium preparations, application of fluoride preparations.

Practice - rubber dam.

A rubber dam is a system for isolating the working area from saliva, as well as protecting adjacent teeth and soft tissues of the oral cavity from damage by the bur.

Indications:

treatment of dental caries

endodontic dental treatment

dental restoration

use of Air-Flow devices

Contraindications:

severe periodontitis

allergy to latex

patient's reluctance.

The set includes: punch, clamp pliers, clamps, latex, chords or wedges.

Using rubber dam:

holes are marked on the latex using a template

holes are made using a punch

latex is placed on the extracted teeth, clamps are fixed on the extracted tooth or on neighboring teeth, fixation with the help of wedges or chords is also possible.

At the clinic, flosses are tied to the clamps (to be pulled out if inhaled or swallowed)

Latex is stretched over the frame

WHO classification of caries. Unfortunately, it doesn't exist unified system classifications of caries that would fully satisfy the requirements of clinicians. Today there are several dozen classifications of caries

When diagnosing carious tooth lesions, dentists use the following classifications:
Caries classification:
1. According to the depth of damage to tooth tissue:
- initial,
- superficial,
- average,
- deep
2. According to pathomorphological changes:
- caries in the spot stage (white spot, light brown spot, black),
- enamel caries (superficial caries),
- average caries,
- medium deep caries (corresponds to deep caries clinic).
3. By localization:
- fissure,
- approximal,
- cervical.
4. According to the degree of disease activity:
- compensated form,
- subcompensated form,
- decompensated form.
5. Basic: WHO classification of caries (ICD-10, 1995):
- enamel caries
- dentin caries
- cement caries.
6. Zonal classification (Lukomsky, 1949).
1. Carious stain: a) chalk-acute process; b) pigmented-chronic.
2. Superficial caries(enamel caries), acute and chronic.
3. Average caries (dentine caries), acute and chronic.
4. Deep caries (caries of suprapulpal dentin), acute and chronic.

7. Classification of MMSI(1989)

I. Clinical forms:
1. Spot stage (carious demineralization):
a) progressive (white or light yellow spots);
b) intermittent (brown spots);
c) suspended (dark brown spots).
2. Carious defect (disintegration):
A. Enamel caries (superficial).
B. Dentin caries:
a) medium depth;
b) deep.

B. Cement caries.
II. By localization:
1) fissure caries;
2) caries of contacting surfaces;
3) caries of the cervical region.
III. With the flow:
1) fast-flowing caries;
2) slow-moving caries;
3) stabilized process.
IV. By intensity of damage:
1) single lesions;
2) multiple lesions;
3) systemic damage.

International classification of diseases ICD-10
- codes and ciphers of diagnoses and diseases.

K00-K93 Diseases of the digestive system
.
K00-K14 Oral diseases, salivary glands and jaws
.
K02 Dental caries
(Dental caries,)
K02.0 Enamel caries
K02.1 Dentin caries
K02.2 Cement caries
K02.3 Suspended dental caries
K02.4 Odontoclasia
K02.8 Other dental caries
K02.9 Dental caries, unspecified
(Tooth caries,)

Dental caries should be considered as a polymorphic pathological process, characterized by focal demineralization of hard dental tissues with the formation of a carious cavity, capable of worsening throughout life, stabilizing, acquiring various activities and being in varying degrees compensation.

There are several ways to classify caries, which allow us to combine different methodological approaches to diagnosis and treatment. In 1999 Russian institutions healthcare transferred statistical medical records to the international classification of diseases according to the World Health Organization (WHO). The classification of caries according to ICD-10 is used in combination with other systems.

Classification according to ICD-10

As a result of many attempts to create a unified system for classifying diseases, the International Classification of Diseases (ICD) was created in the twentieth century. Since 1948, it has been revised and supplemented more than once. The last, tenth, revision took place in 1989. Since 1994, the ICD-10 system began to be implemented in countries that are members of the World Health Organization. All diseases in it are sorted into sections and designated by a three-digit alphanumeric code. Caries according to ICD-10 is assigned the code K02. It belongs to the section “Diseases” digestive system" and the subsection "Diseases of the oral cavity."

Caries according to ICD-10

The classification of caries in this system begins with code K02.0 and ends with code K02.9 and includes seven points:

white spot stage;
dentin disease;
damage to cement;
stationary (suspended) caries;
odontoclasia (it includes melanodontoclasia and melanodentia);
other caries (not included in the description);
unspecified caries.

The classification of caries according to ICD-10 does not completely satisfy clinicians and diagnosticians, because some types of disease are hidden under the vague terms “other” and “unspecified” caries. If caries is classified perfectly by the depth of penetration, then by localization and other characteristics - not so much. Therefore for more full description diseases, dentists have to combine ICD-10 with other classifiers. Typically, the standard Black classification system (by localization) is used for this. There are other caries classification systems that describe the duration or severity of the disease.

Replacing the ICD-10 classifier

Since 2012, work has been underway to improve the ICD-10 classification. The World Health Organization plans to introduce new system- ICD-11. Experts are working on its development: diagnosticians, clinicians and medical practitioners. It is expected that it will have more sub-clauses of caries classification that will be able to cover all medical cases. ICD-11 is designed to solve all the problems that doctors have with the classification of caries according to ICD-10.

Caries is one of the most common dental disease on our planet. Its presence on the surface of the teeth requires mandatory medical intervention in order to prevent their further destruction. And the caries classification system will help you choose a treatment method for a particular clinical case.

Black's classification of carious formations on the surface of teeth was proposed in 1896 in order to determine treatment standards for each individual clinical case.

It included five classes, each of which had its own method of preparing and filling teeth. After the sixth grade was added to the classification, it remained unchanged to this day.

Class I

The first class includes carious lesions of the pits, fissures and natural depressions of the chewing, palatal or buccal surfaces of the teeth - the so-called fissure caries.

Class II

The second class includes caries of the contact surfaces of molars and premolars.

Class III

The third class includes caries of the contact surface of the incisors and canines, which does not affect the integrity of their cutting edges.

Class IV

The next stage is a more intense damage to the incisors and canines, violating the integrity of their cutting edge.

Class V

The fifth class includes damage to the vestibular surface of all groups of teeth - cervical caries.

Class VI

The sixth class includes caries located on the tubercles of the molars and the cutting edges of the incisors and canines.

Classification of caries according to ICD-10 (WHO)

The ICD-10 (World Health Organization) classification is as follows:

dental enamel caries;
dentin caries;
cement caries;
caries that has stopped due to exposure to hygienic and preventive procedures;
odontoclasia, characterized by resorption of the roots of primary teeth;
other caries;
unspecified caries.

According to the depth of the lesion

Based on the depth of damage, caries is divided into several stages.

These include:

initial caries;
superficial caries;
average caries;
deep caries.

Initial caries

The initial stage of development of the disease begins with the formation of a white or dark spot on the surface of the tooth. At the same time, the enamel remains smooth to the touch, since it has not yet reached the point of anatomical destruction.

There is no toothache at this stage, and treatment is carried out with minimal intervention in its structure.

The formed stain is removed using dental equipment and the teeth are remineralized in order to prevent the subsequent development of the carious process.

The next stage in the development of caries is destruction upper layers enamel with the appearance of a reaction to sudden changes in temperature of food and water, as well as sour or spicy foods.

The smoothness of the tooth surface is disrupted and it becomes rough.

Treatment at this stage includes resurfacing of the affected area followed by remineralization. Applies also traditional treatment with preparation and filling.

Medium caries means the destruction of the enamel layer of the tooth with the appearance of periodic or permanent pain. This is due to the fact that the pathogenic process has affected the upper layers of dentin.

Average caries requires mandatory medical intervention, which involves removing the affected area and then restoring it with filling material.

Deep caries is characterized by extensive damage to the internal tissues of the teeth, affecting most dentin.

Ignoring this process and refusing treatment can lead to damage to the pulp with subsequent complication of the disease pulpitis and/or periodontitis. Therefore, the affected area must be removed for subsequent installation of a filling.

Video: types of caries

According to the presence of complications

Based on the presence of complications, caries is divided into complicated and uncomplicated.

Uncomplicated

The uncomplicated caries process includes a typical carious process, including its various stages (superficial, medium, deep).

Complicated

Complicated caries includes a disease accompanied by the development of concomitant inflammatory processes. Most often, this is a consequence of late consultation with a doctor or insufficient treatment.

By degree of activity

To assess the degree of disease activity, the Vinogradova classification is used, based on the division of caries into compensated, subcompensated and decompensated.

Compensated

Compensated caries is characterized by a sluggish or non-progressive process. Damage to the surface of the teeth is insignificant and does not cause any discomfort in the patient.

With regular hygiene procedures, as well as holding special preventive measures it is possible to stop the development of the disease at its initial stages.

Subcompensated

Subcompensated caries is characterized by an average rate of progression, at which it can go unnoticed and not cause concern to the patient at all.

Decompensated

Decompensated caries is characterized by intensive development and course, accompanied by such acute pain that this affects the patient's ability to work. Because of this, the disease is often called acute caries.

It requires immediate medical procedures, since otherwise the process may spread to third-party teeth with the subsequent addition of pulpitis and periodontitis.

According to the nature of the flow

According to the nature of the course, caries is divided into acute, chronic, acute and recurrent.

Acute caries characterized by the appearance of signs of dental damage within just a few weeks.
Chronic caries develops over a longer period of time. At the same time, the affected tissues have time to become stained with plaque and food coloring, acquiring colors from yellow to dark brown.
Acute or blooming caries characterized by multiple lesions of dental tissue within a fairly short time. This phenomenon often observed in children with low immunity, as well as in adults after removal of the salivary glands, accompanied by dry mouth.
Recurrent and secondary caries is a consequence of a number of provoking factors. These include damage or weakening of tooth enamel, failure to comply with personal hygiene rules, as well as decreased immunity due to any diseases of the body.

According to the intensity of the process

According to the intensity of the process, the disease is divided into single and multiple caries.

In the first case, one tooth is involved in the process, and in the second - several teeth at the same time. Defeat large quantity teeth in a short period of time is called generalized caries.

By process localization

According to the localization of the process, caries is divided into fissure, interdental, cervical, circular and hidden.

Fissure or occlusal caries characterized by the development of lesions in the natural recesses of the chewing surface of the teeth.
Interdental or proximal caries develops on the contact surfaces of teeth, and for a long time may not be visualized. This is due to the specifics of the development of the disease: affecting the surface of the tooth, caries develops towards its center, while the cavity itself is often covered by a preserved layer of enamel. You can find it using x-ray or by dark areas showing through the teeth.
Cervical or cervical caries develops in areas of the teeth located between their crown and root closer to the gum - on the neck. Is a consequence insufficient hygiene oral cavity.
Circular or ring caries characterized by circumferential damage to the tooth surface. Appearance the disease resembles a yellow or brown belt around the neck of the teeth, with more than half clinical cases falls on children.
Hidden caries characterized by damage to areas that are difficult to see, such as dental crevices.

According to the primacy of development

Based on the priority of development, caries is divided into primary and secondary.

Primary caries develops either on an intact tooth or on an area that has not previously been treated.

Secondary caries is recurrent because it appears on the treated sites, that is, where a filling was previously installed. Due to the fact that the location of the disease is often the area located under a filling or dental crown, it is called internal caries.

Video: why fillings need to be replaced

Classification in children

The principles of classification of caries in children are practically no different from adults. The only difference is the division of its parameters into caries permanent teeth and caries of primary teeth.

In the latter case, the picture of the lesion is of the same nature as in adults, but due to the temporary purpose of baby teeth, treatment is carried out somewhat differently.

Due to the characteristics of the development of caries, several classifications have been identified. We present the main classifications of caries

In accordance with changes in hard tissues and clinical manifestations Several types of classification of dental caries have been created, they are based on various signs.

According to the WHO classification, caries is classified as a separate category.

Classification of caries ICD-10

K02.0 enamel stage of chalk stain (initial caries)
K02.1 Dentin caries
K02.2 Cement caries
K02.3 Suspended dental caries
K.02.3 Odontoclasia
Pediatric melanodentia
Melanodontoclasia
K02.8 Other dental caries
K02.9 Dental caries, unspecified

The advantages of this classification include the introduction of the subcategories “arrested caries” and “cement caries”.

Topographic classification of dental caries

In our country, this classification is most widely used. It takes into account the depth of the lesion, which is very convenient for the practice of the dentist.

– focal demineralization of the hard tissues of the tooth is observed, and it can occur intensively (white spot) or slowly (brown spot).
– at this stage a carious cavity appears within the enamel.
– at this stage, the carious defect is located within the surface layer of dentin (mantle dentin).
– in this case, the pathological process reaches the deep layers of dentin (peripulpal dentin).

IN clinical practice The terms “secondary caries” and “recurrent caries” are also used; let’s take a closer look at what they are:

1)Secondary caries– these are all new carious lesions that develop next to the filling in a previously treated tooth. Secondary caries has all the histological characteristics of a carious lesion. The reason for its occurrence is a violation of the marginal seal between the filling and the hard tissues of the tooth; microorganisms from the oral cavity penetrate into the resulting gap and create optimal conditions for the formation of a carious defect along the edge of a filling in enamel or dentin.

2) Recurrence of caries is renewal or progression pathological process in case the carious lesion was not completely removed during previous treatment. Recurrence of caries is more often found under a filling when x-ray examination or along the edge of the filling.

Clinical classification of dental caries

Acute caries. It is characterized by the rapid development of destructive changes in the hard tissues of the tooth, the rapid transition of uncomplicated caries to complicated ones. The affected tissues are soft, slightly pigmented (light yellow, grayish-white), moist, and can be easily removed with an excavator.
Chronic caries is characterized as a slow process (several years). The spread of the carious process (cavity) is mainly in the planar direction. The altered tissues are hard, pigmented, brown or dark brown in color.
There are also other forms of caries, for example, “acute”, “blooming caries”.

Classification of carious cavities according to Black

Class 1 – cavities located in the area of fissures and natural recesses (for example, the blind fossa of the lateral incisors);

Class 2 – cavities located on the contact surfaces of small and large molars;

Class 3 – cavities located on the contact surfaces of the incisors and canines while maintaining the cutting edge;

Class 4 – cavities located on the contact surfaces of the incisors and canines with violation of the angles and cutting edge of the crown;

Class 5 – cavities on the labial, buccal and lingual surfaces located in the gingival part of the crown.

IN Lately class 6 is distinguished, which Black did not describe; these are cavities located on the tubercles of the molars and on the cutting edge of the incisors and canines.