Hygienic index Kuzmina. Indices of the state of the oral cavity methods for assessing dental plaque

Oral hygiene is one of the most accessible and at the same time one of the leading methods of preventing oral diseases. Regular and competent oral care is an integral part of all preventive measures. Mass surveys of the population conducted in all countries of the world have convincingly shown that systematic oral care has an undoubted preventive value. An objective assessment of the level of oral hygiene is possible only with the use of hygienic indices.

To identify dental deposits in the assessment of oral hygiene in modern dentistry, objective indicators (indices) are used that characterize the quality and quantity of dental deposits. However, the number of assessment methods based on a different number of teeth from different functional groups, up to staining all teeth on both sides or collecting and weighing plaque around individual teeth, indicates the relevance of the problem under consideration and the imperfection of existing methods.

Indices of oral hygiene.

Method for determining the hygienic index of Fedorov-Volodkina// E.M. Melnichenko "Prevention of dental diseases", Minsk, "Higher School", 1990, pp. 3-17.

It is determined by the intensity of the color of the vestibular surface of the six lower frontal teeth by applying an iodine-iodine-potassium solution (Shiller-Pisarev liquid).

The calculation is carried out according to the formula:

Ksr (hygiene index) = Kn (total hygiene index for each of the six teeth) / n (number of teeth).

Staining of the entire surface of the crown is estimated at 5 points, 3/4 of the surface - 4, 1/2 of the surface - 3, 1/4 of the surface - 2 points. In the absence of staining put 1 point. The indicator is evaluated as follows: good index, satisfactory, unsatisfactory, poor, very poor.

However, the proposed method has several disadvantages:

Determination of the quality and quantity of dental deposits, assessment of the hygiene index were carried out only on own teeth;
- the use of known dyes is impossible when determining the amount of dental deposits on bridges, since these solutions are difficult to wash off the surface of the prostheses.

Name

Facilities

diagnostics

Criteria for self-control

Lugol's solution

1.1-1.5-good

1.6-2.0 - satisfactory

2.1-2.5 - unsatisfactory

2.6-3.4 - bad

3.5-5.0 - very bad

The vestibular surface of the six front teeth is stained with Lugol's solution. mandible- incisors and canines. Evaluation on a 5-point system:

5 points - the entire surface of the teeth is stained,

4 points - 3/4 of the tooth surface,

3 points - 1/2 tooth surface,

2 points - 1/4 of the tooth surface,

1 point - no staining

Then the arithmetic mean is found by dividing the sum of the coloring of all teeth by their number: K cf = Kp: p.

Good level of hygiene: Kcp = 1.0-1.3 b

IG = score of six teeth
6.

Schiller-Pisarev solution or Lugol solution

0-0.6 good

0.7-1.6 satisfactory

1.7-2.5 unsatisfactory

2.6-3 - bad

Determine the presence of plaque and tartar on the buccal surface of the first upper molars, the lingual surface of the lower molars, the vestibular surface 1| and lower |1

6 1| 6
6 | 1 6.
On all surfaces, plaque is first determined, then tartar.

0 - no plaque (stone)

1 - plaque covers up to 1/3 of the tooth surface

2 - plaque covers from 1/3 to 2/3 of the tooth surface

3 - plaque covers more than 2/3 of the tooth surface

Calculus assessment:

0 - no tartar

1 - supragingival tartar covers no more than 1/3 of the tooth crown

2 - supragingival tartar covers from 1/3 to 2/3 of the crown of the tooth, or single formations of subgingival tartar are determined

3 - supragingival calculus covers more than 2/3 of the tooth crown, or significant deposits of subgingival calculus are determined around the entire circumference of the tooth.

ISN = sum of indicators of 6 teeth
6

Assessment of the tartar index is carried out in the same way

Schiller-Pisarev solution

0-no staining

1- staining up to 1/3 of the crown,

2- staining up to 2/3 of the crown

3- more than 2/3 of the crown of the tooth

Staining of the vestibular and lingual surface

6 1 | 6
6 | 1 6

The plaque index and the stone index are summed up and the average is obtained.

PHP Index - Oral Hygiene Efficiency Index (Podshadley, Haley - 1968)

Stain 6 teeth:

16, 26, 11, 31 - vestibular surfaces.

36, 46 - lingual surfaces

The examined surface is divided into 5 sections: 1-medial, 2-distal, 3-mid-occlusal, 4-central, 5-mid-cervical.

Plaque is assessed at each site:

0 - no staining

1 - staining detected

For each tooth, the area codes are summed. Then the values of all the examined teeth are summed up and the resulting sum is divided by the number of teeth.

Index values:

0 - excellent

0.1-0.6 - good

0.7-1.6 - satisfactory

1.7 or more - unsatisfactory

Index of need in the treatment of periodontal diseases - CPITN

To assess the prevalence and intensity of periodontal diseases in almost all countries, the index of need for the treatment of periodontal diseases is used - CPITN. This index was proposed by experts from the WHO working group to assess the state of periodontal tissues during epidemiological surveys of the population.

At present, the scope of the index has expanded, and it is used to plan and evaluate the effectiveness of prevention programs, as well as to calculate the required number of dental personnel. In addition, the CPITN index is currently used in clinical practice to examine and monitor the condition of the periodontium in individual patients.

This index registers only those Clinical signs that can undergo reverse development: inflammatory changes in the gums, which are judged by bleeding, tartar. The index does not register irreversible changes (gingival recession, tooth mobility, loss of epithelial attachment), does not indicate the activity of the process and cannot be used to plan a specific clinical treatment in patients with advanced periodontitis.

The main advantages of the CPITN index are the simplicity and speed of its determination, the information content and the ability to compare results.

To determine the CPITN index, the dentition is conditionally divided into 6 parts (sextants), including the following teeth: 17/16, 11, 26/27, 36/37, 31, 46/47.

Examine the periodontium in each sextant, and for epidemiological purposes only in the area of the so-called "index" teeth. When using an index for clinical practice examine the periodontium in the area of all teeth and highlight the most severe lesion.

It should be remembered that the sextant is examined if it contains two or more teeth that cannot be removed. If only one tooth remains in the sextant, it is included in the adjacent sextant, and this sextant is excluded from the examination.

In the adult population, starting from 20 years of age and older, examine 10 index teeth, which are identified as the most informative:

When examining each pair of molars, only one code characterizing the worst condition is taken into account and recorded.

For persons under 20 years of age, during an epidemiological examination, 6 index teeth are examined: 16, 11, 26, 36, 31, 46.

CODE 1: Bleeding observed during or after probing.

Note: bleeding may appear immediately or after 10-30 seconds. after probing.

CODE 2: Tartar or other plaque-retaining factors (overhanging edges of fillings, etc.) are visible or felt during probing.

CODE 3: pathological pocket 4 or 5 mm (gingival margin is in the black area of the probe or the 3.5 mm mark is hidden).

CODE 4: Abnormal pocket 6 mm deep or more (whereby the 5.5 mm mark or black area of the probe is hidden in the pocket).

CODE X: when only one tooth or no teeth are present in the sextant (third molars are excluded unless they are in place of the second molars).

To determine the need for treatment of periodontal disease, population groups or individual patients can be assigned to appropriate categories based on the following criteria.

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

1: A CODE of 1 or higher indicates that this patient needs improved oral hygiene.

2: a) 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.

b) 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.

3: 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 it is required complex treatment, which includes deep curettage.

The prevalence and intensity of periodontal disease in the population is estimated from the results of a survey of 15-year-olds.

The prevalence of signs of periodontal disease (teenagers 15 years old)

Prevalence Bleeding gums Tartar

low 0 - 50% 0 - 20%

medium 51 - 80% 21 - 50%

high 81 - 100% 51 - 100%

The level of intensity of signs of periodontal damage (teenagers 15 years old)

INTENSITY LEVEL

LOW 0.0 - 0.5 sextants 0.0 - 1.5 sextants

AVERAGE 0.6 - 1.5 sextants 1.6 - 2.5 sextants

HIGH< 1,6 секстантов < 2,6 секстантов

Gingivitis index РМА (Schour, Massler) in Parma modification

Gingivitis index RMA (Schour, Massler) in the Parma modification (determination of risk factors) - papillary-marginal-alveolar index is calculated by adding the estimates of the state of the gums for each tooth in% according to the formula:

RMA = sum of indicators x 100%

3 x number of teeth

0 - no inflammation,

1 - inflammation of the interdental papilla (P)

2 - inflammation of the marginal gums (M)

3 - inflammation of the alveolar gums (A)

At the age of 6-7 years, the number of teeth is normally 24, 12-14 years - 28, and at 15 years and older - 28 or 30.

The PMA index is very sensitive to the slightest changes in the clinical picture, and random influences can influence its value.

COMPLEX PERIODONTAL INDEX, KPI(P.A.Leus, 1988)

Methodology. The state of periodontal tissues is determined using a conventional dental probe and a dental mirror; dental tweezers can be used to determine mobility. In adults, 17/16, 11, 26/27, 37/36, 31, 46/47 are examined. If there are several signs, a more severe condition is recorded (higher score).

Criteria

0 - healthy - plaque and signs of periodontal damage are not determined;

1- dental plaque - any amount of plaque;

2- bleeding - bleeding visible to the naked eye with light probing of the periodontal groove;

3 - tartar - any amount of tartar in the subgingival region of the tooth;

4 - pathological pocket - pathological periodontal pocket, determined by the probe;

5 - tooth mobility - mobility of 2-3 degrees

The KPI of an individual is calculated by the formula:

CPI = Sum of codes / number of sextants (usually 6)

Interpretation:

Values Intensity level

0.1-1.0 Risk to disease

1.1-2.0 Light

2.1-3.5 Medium

3.6-5.0 Heavy

Index CPI- communal periodontal index.

Designed to determine the state of periodontal tissues in epidemiological studies. The condition of periodontal tissues is assessed by:

Presence of subgingival calculus

Bleeding gums after gentle probing

By the presence and depth of pockets

For the study, a special bellied probe is used:

Weight 25 grams

Button diameter 0.5 mm

Marking 3-5-8-11 mm

Distance between 3 and 5 mm black

In persons from 15 to 20 years old, teeth 11, 16, 26, 31, 36, 46 are examined. In persons over 20 years old, teeth are examined: 11, 16, 17, 26, 27, 31, 36, 37, 46, 47.

Research is carried out from the vestibular and oral surfaces, in the distal and medial areas

Research methodology:

1. The working part of the probe is placed parallel to the long axis of the tooth

2. The probe button with minimal pressure is inserted into the space between the tooth and soft tissues until you feel an obstacle

3. Mark the depth of the probe

4. During extraction, the probe is pressed against the tooth to determine if there is a subgingival calculus on it

5. At the end of the study, after 30-40 seconds, observe the gum to determine bleeding

Data logging:

0 - healthy gum

1 - bleeding after 30-40 seconds, with a pocket depth of less than 3 mm

2 - subgingival tartar

3 - pathological pocket 4-5 mm

4 - pathological pocket 6 mm or more

If there are several symptoms, the most severe of them is recorded.

In each sextant, the periodontal condition of only one tooth is recorded, fixing the tooth with the most severe periodontal clinical condition.

To evaluate the index, the proportion of persons who have a particular number of sextants with a particular code is calculated.

Iodine index of enamel remineralization.

Known active permeability of iodine in the tooth tissue. Remineralization index (IR), which characterizes the effectiveness of the applied remineralizing therapy. It is evaluated on a four-point system:

1 point - no staining of the tooth area;

2 points - light yellow staining of the tooth area;

3 points - light brown or yellow staining of the tooth area;

4 points - dark brown staining of the tooth area.

The calculation is carried out according to the formula:

IR \u003d IRNP x number of teeth with increased sensitivity / n,

where RI is the remineralization index;

IRNP - index of remineralization of one non-carious lesion;

P - number of examined teeth.

Dark brown and light brown staining indicates demineralization of the tooth area with non-carious lesions; light yellow - indicates a certain level of remineralization processes in this area of the tooth, and the absence of staining or its slightly yellow color demonstrates a good level of the remineralization process of one or another non-carious tooth lesion.

The prevalence and severity of hyperesthesia of hard dental tissues

(Fedorov Yu.A., Shtorina G.B., 1988; Fedorov Yu.A. et al., 1989).

The calculation of the index is carried out according to the formula and expressed as a percentage:

The number of teeth with increased sensitivity \u003d / The number of teeth in this patient x 100%.

Depending on the number of teeth with sensitivity to various stimuli, the index varies from 3.1% to 100.0%.

3.1-25% are diagnosed with a limited form of hyperesthesia

26-100% - generalized form of hyperesthesia of the teeth.

Dental Hyperesthesia Intensity Index (IIGI)

calculated by the formula:

HIHI = Sum of index values of each tooth / Number of sensitive teeth

The index is calculated in points, which are determined based on the following indicators:

0 - no response to temperature, chemical and tactile stimuli;

1 point — the presence of sensitivity to temperature stimuli;

2 points - the presence of sensitivity to temperature and chemical stimuli;

3 points - the presence of sensitivity to temperature, chemical and tactile stimuli.

Values of the intensity index of hyperesthesia of hard tissues of teeth

1.0 - 1.5 points hyperesthesia of the 1st degree;

1.6 - 2.2 points - II degree;

2.3 - 3.0 points - III degree.

The listed indices correlate with each other in 85.2-93.8% of cases and allow adequate and objective control of the intensity and severity of the pathological process, to monitor the dynamics of changes during treatment.

INDIVIDUAL ORAL HYGIENE is a scientifically based system of individual treatment and prophylactic measures that are carried out with the help of personal oral hygiene products aimed at improving the organs and tissues of the oral cavity and preventing the occurrence and progression of dental diseases. It is based on an individual hygiene prevention program and consists of daily hygiene and preventive procedures.

HYGIENE AND PREVENTIVE PROCEDURE - a system of successive stages of caring for the organs and tissues of the oral cavity, taking into account the individual characteristics of each patient (dental and hygienic status) and a specific set of personal oral hygiene products selected in accordance with them.

PROFESSIONAL ORAL HYGIENE is a scientifically based system of therapeutic and preventive measures performed by medical personnel, aimed at improving the organs and tissues of the oral cavity and preventing the onset and progression of dental diseases. Professional oral hygiene measures are carried out at least 2 times a year.

The main activities of professional oral hygiene can be divided into 3 groups: 1. Preventive examination of the patient with the definition of hygienic indices; measures to prevent caries (including fissure) and periodontal disease with the removal of supra- and subgingival dental deposits using special equipment, followed by grinding and polishing of tooth tissues

2. Educational formation of knowledge about the anatomical and physiological characteristics of the oral cavity organs, about personal oral hygiene products, teaching the rules for their use, development individual programs hygienic prevention of major dental diseases

3. Therapeutic and preventive hygiene preparation before surgery (for periodontal disease, implantation) and rehabilitation measures in the postoperative period (including anti-inflammatory, physiotherapy treatment); clinical examination and rehabilitation of patients with decompensated form of caries, with diseases of the oral mucosa and periodontium; teeth whitening; treatment of hyperesthesia of hard dental tissues; measures for deep fluoridation; checking the closure of the dentition of the upper and lower jaws; identification of preliminary contacts; selective grinding of teeth

Carisogenic factors General local Diet Concomitant diseases Extreme exposures Plaque bacteria Properties and composition of the oral fluid Dietary residues Genetic features Enamel structure Enamel structure Chemical composition enamel Chemical composition of enamel

Etiological prevention Fight against oral microflora (antiseptics) Elimination of waste products of microflora (enzymes, surfactants, herbal preparations) Professional hygiene Self-cleaning of the oral cavity (diet, creation of conditions in oral cavity)

Classification of acquired structures of the oral cavity (G.N. Pakhomov) 1. Non-mineralized dental deposits: Pellicle Dental plaque Soft plaque Food residues 2. Mineralized dental deposits: Supragingival calculus Subgingival calculus

Dyes for the detection of plaque Schiller's solution - Pisarev Lugol's solution Lugol's solution with glycerin 6% fuchsin solution Methylene blue Erythrosin KJ - 2.0; J - 1.0; H 2 O - 40.0 KJ - 2.0; J - 1.0; H 2 O - 17.0 KJ - 2.0; J - 1.0; H 2 O - 3.0 glycerin - 94.0 ethyl alcohol - 70% 25.0; fuchsin - 1.5

Oral hygiene indices Fedorov-Volodkina index Fedorov-Volodkina index G.N. Pakhomov Index G.N. Pakhomova JCGreen Oral Hygiene Index, JRVermillion (IGR-U, OHI-S) JCGreen Oral Hygiene Index, JRVermillion (IGR-U, OHI-S) Oral Hygiene Effectiveness Index (PHP) Oral Hygiene Effectiveness Index (PHP)

Fedorov-Volodkina index Evaluation codes: 1 - no plaque detected 1 - no plaque detected 2 - staining 1/4 of the surface 2 - staining 1/4 of the surface 3 - staining 1/2 3 - staining 1/2 4 - 3/4 4 - 3/4 5 - the entire surface 5 - the entire surface

Fedorov-Volodkina index Number of examined teeth Formula: Sum of indicators Interpretation of the index: 1.1 - 1.5 - good level of hygiene 1.6 - 2.0 - satisfactory 1.6 - 2.0 - satisfactory 2.1 - 2.5 – unsatisfactory 2.6 – 3.4 – poor 3.5 – 5.0 – very poor

JCGreen Oral Hygiene Index, JRVermillion Plaque rating codes: 0 - no plaque detected 0 - no plaque detected 1 - soft plaque covering no more than 1/3 of the tooth surface or the presence of any amount of stained deposits 1 - soft dental plaque covering no more than 1/3 of the tooth surface or the presence of any amount of colored deposits 2 - 1/3 - 2/3 2 - 1/3 - 2/3 3 - more than 2/3 3 - more than 2/3 IGR-U = Sum of plaque values Number of surfaces

JCGreen Oral Hygiene Index, JRVermillion Tartar score codes: 0 - no calculus detected 1 - supragingival calculus covering no more than 1/3 of the tooth surface 2 - supragingival calculus covering 1/3 to 2/3 of the surface, or the presence of individual deposits of subgingival calculus in the cervical area 3 - supragingival calculus - more than 2/3 of the surface, or significant deposits of subgingival calculus Sum of calculus values Number of surfaces IGR-U =

JCGreen Oral Hygiene Index, JRVermillion Index interpretation for plaque or tartar: 0 - 0.6 - good hygiene 0 - 0.6 - good hygiene 0.7 - 1.8 - fair 0.7 - 1.8 – satisfactory 1.9 – 3.0 – poor 1.9 – 3.0 – poor

Sum of stone values Number of surfaces IGR-U = Sum of plaque values Number of surfaces + Oral hygiene index J.C.Green, J.R.Vermillion Index interpretation: 0 – 0.6 – low index; good hygiene 0.7 - 1.6 - average index; satisfactory 1.7 - 2.5 - high; unsatisfactory 2.6 - 3.0 - very high; bad

Dental health affects the entire body. Ways to prevent problems - regular hygiene, periodic visits to the doctor. The dentist will analyze the health of the mucous membranes, gums, crowns according to hygiene indices, which quantitatively show the degree of the disease, helping to control the degree of its development.

Expert opinion

Biryukov Andrey Anatolievich

doctor implantologist orthopedic surgeon Graduated from the Crimean Medical Institute. institute in 1991. Specialization in therapeutic, surgical and orthopedic dentistry including implantology and prosthetics on implants.

Ask an expert

I think that you can still save a lot on visits to the dentist. Of course I'm talking about dental care. After all, if you carefully look after them, then the treatment really may not reach the point - it will not be required. Microcracks and small caries on the teeth can be removed with ordinary paste. How? The so-called filling paste. For myself, I single out Denta Seal. Try it too.

Hygiene indices are data that evaluate enamel contamination, the presence of bacteria, hard plaque, show the number of healthy, and also crowns, partially or affected by carious foci. According to the final figures, the doctor will find out the stage of destruction of dental units, the thoroughness of cleaning, tissue and bite problems, and the effectiveness of the prescribed treatment.

For each type of damage to the jaw units, gums, there are special evaluation parameters, which will be discussed below.

Types of KPU

The basic indicator taken into account by the dentist is PU. He talks about the intensity of carious lesions of the teeth. The following data is evaluated:

K - foci of identified areas of caries;
P - fillings;
U - extracted teeth.

In sum, the information shows how intensively caries spreads:

KPU of cavities - number of cavities as a result of filling, caries;
KPU of available surfaces - the number of external areas damaged by caries;
KPU teeth - the number of affected, sealed.

KP is used for milk teeth, where the letter K denotes caries, P - sealed teeth. In babies, lost, removed milk teeth are not taken into account.

KPU assessment

To determine the level of caries developing in the mouth, 3 indicators are used, getting the number of percent. For calculations, the number of patients with caries is taken, divided by the total number of patients examined, then multiplied by 100. Comparing the health of people regionally, they conduct an examination in 12-year-old patients. The obtained data on the prevalence of caries are interpreted as follows:

less than 30% - low;
30-80% - medium;
80-100% - high.

The strength of the infection is determined by the number of teeth affected by caries. Get 5 degrees. In 12-year-old patients, the degree is:

less than 2.6 - very low;
2.6-4.4 - moderate;
4.4-6.4 - high;
more than 6.5 - very high.

In 35-year-old patients, the degree is:

less than 1.5 - very low;
1.5-6.2 - low;
6.2-12.7 - moderate;
12.7-16.2 - high;
more than 16.3 - very high.

An increase is a change in values during subsequent examinations of the patient for the worse. Thanks to this assessment, the level of current health is studied, an individual treatment regimen is prescribed.

Disadvantages of the CPU

In addition to the obvious benefits, the CPU has disadvantages. They are the following:

the summarized picture is influenced by the past dynamics of the spread of caries, which increases with adulthood;
the calculations take into account both cured and extracted teeth;
the initial stages of caries are not taken into account.

Taking into account the nuances of the assessment above, the results of the KPU do not give the doctor a reliable picture of the health of the oral cavity, since fillings fall out over time, foci of caries appear further, and when the data is summarized with past examinations, the final picture becomes less / strongly distorted.

Periodontal indices

Information about the condition of the periodontium visualizes the dynamics of infection of the gums - the spread of the existing pathology, the depth of the lesion, and control the success of the treatment. Data are presented that allow to obtain a picture of the state of the periodontium. In one visit to the dentist, you can undergo a study by several methods, which will give a complete picture.

Papillary-marginal-alveolar index (pma)

This is one of the main tests. Reveals gingivitis, its duration, depth. The doctor will note problematic moments in the patient's mouth, fill in the statement with points, noting the identified localization of the lesion:

1 - affected papilla;
2 - marginal gum inflamed;
3 - a problem with the alveolar gum.

According to the final calculations, the average number is derived, revealing the stage of gingivitis:

up to 30% - light;
30-60% - medium;
more than 60% - severe.

Periodontal index (PI)

Signs of gingivitis, as well as its degree. The dentist evaluates the presence of mobility, destruction bone tissue, periodontal pockets, scoring:

0 - no lesions;
1 - unilateral mild inflammation;
2 - the tooth holds well, but is surrounded by inflammation;
4 - X-ray reveals resorption of the tops of the partitions;
6 - if there is a pocket, the tooth does not hurt, it holds firmly;
8 - tissues are destroyed, the tooth is shaky, it is displaced.

less than 1.5 - the first;
1.5 - 4 - the second;
4 - 8 - the third.

The indicator signals the need to treat periodontal diseases. The mucous membranes near the teeth of both jaws are subject to examination. The specialist examines with a probe, revealing hard plaque, pockets, bleeding. The results are displayed in numbers:

0 - no problem;
1 - due to the action of the instruments used during the test - blood;
2 - there is a stone;
3 - the presence of a periodontal pocket 5 mm;
4 - the presence of a periodontal pocket more than 6 mm.

For each verified unit, the scores are summed up, after which the entire amount will be divided by 6, getting the numbers:

0 - no need to treat;
1 - requires cleaning, regular visits to the dentist;
2-3 - professional cleaning is necessary;
4 - the need for complex therapy.

Pocket depth gauge

The presence of pockets is a clear symptom of periodontitis. They are not only uncomfortable while eating, but become a source of bad smell because food remains rot inside. The severity of inflammation is indicated by the depth of the pockets. The measurement is carried out with a probe, lowering it into a pocket and observing the scale. A depth of up to 2 mm is considered normal. With initial gingivitis - 3.5 mm, average - more than 4 mm, and if more than 5 mm - significant inflammation, deformation is diagnosed.

It is an average number signaling periodontal damage in the subjects. Tests are carried out in groups - in children 3-4 years old, adolescents 7-14 years old, patients over 18 years old. You will need tweezers and a probe to establish the dimensions of clusters and pockets, the mobility of canines, incisors, molars. The average CPI is an estimate of the overall values in all examined patients. The data obtained show the intensity of the spread of periodontitis:

less than 1 - a small prospect of periodontitis;
1-2 - tissues are barely affected;
2-3,5 – average degree defeat;
3.5-6 - serious severity.

Gingivitis index

The IG number indicates the localization, the degree of spread of the disease. Numbers 12, 16, 24, 32, 36, 44 are examined. For each unit, the dentist displays estimates from four sides - the distal, as well as the core, medial and lingual department. A visual assessment is sufficient, when necessary, a probe is applied. The ratings will be as follows:

0 - no inflammation;
1 - structure, color of gum tissue slightly changed, no bleeding;
2 - swollen gums, changed color, bleeds a little;
3 - severe swelling, inflammation of the gums, and the slightest damage causes bleeding.

After the examination, the doctor sums up the points, divides the number by the number of examined teeth, receiving:

up to 1 - a mild form of gingivitis;
1-2 - middle stage;
2-3 - heavy.

Ramfiord index

Periodontal diseases are indicated. Checking the lingual, vestibular facet, identifying the accumulation of soft, hard deposits. The indicator of gingivitis is displayed:

0 - norm;
1 - inflamed area;
2 - significant gum disease;
3 - condition in severe form.

Indicators of periodontitis will be as follows:

0-3 - the dimensions of the studied pocket are considered acceptable;
4 – the depth of the investigated pocket is less than 3 mm;
5 - depth 3-6 mm;
6 - a pocket with a depth of more than 6 mm.

There are signs of gingivitis, a possible periodontitis. Test according to Muhlemann and Son. When the gums are healthy in appearance, but may bleed with any small lesion. The dentist, barely pressing, circles the line near the tooth with a probe, evaluates the reaction:

0 - no reaction;
1 - blood comes out after 30 seconds;
2 - blood will come out immediately or up to 30 seconds;
3 - bleeding is provoked by brushing your teeth, eating.

Simplified Bleeding Index

Testing is an assessment of the responses of the subject. The dentist is interested in whether there is gum bleeding, what situations provoke it, then assumes the degree of inflammation (approximately).

PBI by Saxer and Miihiemann

Using a probe, the doctor draws a furrow along the papillae between the teeth, assessing the severity of inflammation:

0 - no reaction;
1 - point hemorrhages;
2 - a lot of hemorrhages;
3 - bleeding fills the furrow.

Hygiene indexes

Enamel contamination is assessed - accumulations of deposits are assessed qualitatively, quantitatively. Below are the main indexes.

Fedorova-Volodkina

The test is common among dentists, it comes down to staining the incisors on the bottom with a solution of iodine. The following is the response:

1 - no color;
2 - color ¼ of the surface;
3 - color ½ tooth;
4 - color ¾ of the surface;
5 - the whole tooth is stained.

The doctor will divide the points received by 6, receiving the following transcript:

less than 1.5 - excellent;
1.5-2 - a good level of hygiene care;
2-2.5 - insufficient cleaning;
2.5-3.4 - poor care;
3.4-5 - hygiene is almost invisible.

Green Vermilion

Evaluate loose plaque, as well as hardened. The doctor examines the numbers: 46, 11, 26, 16, 31, 36. The assessment of the upper molars and incisors is carried out from the vestibular part, and the lower ones from the lingual. Based on the results, the final scores are displayed:

0 - clean;
1 - 1/3 of the surface with deposits;
2 - 2/3 parts with deposits;
3 - contamination of more than 2/3 of the tooth.

For the checked unit, a separate assessment of pollution and stone is affixed, the totals are divided by 6, it turns out:

less than 0.6 - excellent;
0.6-1.6 - a decent level of purity;
1.6-2.5 - not clean enough;
2.5-3 - dirty.

Silnes Low

The jaw is analyzed. Coloring is not required, a probe is used. Points:

0 - clean;
1 - a thin layer of pollution;
2 - plaques;
3 - surface coating.

Contamination is detected on the incisors and canines at the junction with the gums:

0 - clean;
1 - deposits up to 0.5 mm;
2 - stone up to 1 mm;
3 - the width of the stone exceeds 1 mm.

Plaque Index by Quigley and Hein

Assessment of accumulations of deposits of both jaws by numbers: 43, 11, 12, 21, 22, 23.13, 31, 32, 33, 41, 42. The surface is stained with fuchsin, after which the doctor checks the vestibular faces:

0 - no color;
1 - coloring in the area of the neck;
2 - color 1 mm;
3 - accumulation of more than 1 mm, but less than 1/3 of the surface;
4 - deposits cover up to 2/3 of the tooth;
5 - pollution covers more than 2/3 of the surface.

API by Lange

It is important to provide proper care for the proximal surfaces, it is their cleanliness that will show the doctor how well the patient is performing dental hygiene. The mucosa is stained with a special solution, contamination is detected from the oral and vestibular sides, depending on the quadrants. The score is displayed as a percentage:

up to 25% is a good indicator;
up to 40% - quite acceptable hygiene;
up to 70% - satisfactory care;
over 70% - insufficient hygiene.

Ramfiord index

The plaque is assessed from the palatine, lingual, and vestibular sides according to the numbers 46, 14, 26, 11, 31, 34. The surface is preliminarily stained with Bismarck's solution. Taking into account the nature of the accumulations, they derive:

0 - clean;
1 - partially there are deposits;
2 - deposits cover the faces, but less than ½;
3 - the deposition covers the faces more than ½.

Navi

Evaluation of the anterior incisors from the side of the lips. The mouth is preliminarily rinsed with a solution of fuchsin, then staining is evaluated:

0 - clean;
1 - coloring of the border with gums;
2 - a wide strip of plaque near the gums;
3 - from the gums 1/3 of the tooth is covered with dirt;
4 - plaque covered up to 2/3;
5 - the deposit covers more than 2/3.

Tureski

The oral cavity is rinsed with a staining solution of fuchsin, then the accumulation of plaque is evaluated on the entire dentition:

0 - clean;
1 - a little plaque at the neck;
2 - deposits 1 mm;
3 - deposits more than 1 mm, but less than 1/3;
4 - pollution up to 2/3;
5 - plaque more than 2/3.

Arnim

The area of pollution is measured. Estimation is laborious, used in scientific research but not for routine inspections. The anterior incisors of both jaws, previously stained with erythrosin, are evaluated. A vestibular picture is taken, magnified 4 times, and a printout is performed. Next, the contour of the incisors, painted surfaces is transferred to the paper, the dimensions of the plaque area are determined by the planimer.

PFRI by Axelsson

First, the oral cavity passes professional cleaning, then you can not brush your teeth for 24 hours. Next, the doctor stains the mucous membranes, evaluates the amount of plaque, revealing the number of dirty teeth among those present:

up to 10% - very low plaque formation rate;
10-20% - low speed;
30% - medium;
30-40% - high;
over 40% is very high.

Hygiene efficiency

Checking for thoroughness. RNR evaluates the numbers 46, 11, 16, 31, 36, 26, pre-rinse the mouth with a dye solution to assess the intensity of staining of each of the 5 parts (distal, as well as medial, central, with them occlusal, cervical). The result of the sector is displayed in points:

0 - clean;
1 - painted.

Do you get nervous before visiting the dentist?

YesNot

0 - excellent hygiene;
0.6 - good cleaning;
up to 1.6 - a satisfactory level;
over 1.7 - poor hygiene.

Stages of epidemiological testing

Epidemiologists study the spread of the disease among people from different walks of life. The examination in dentistry is carried out in three stages:

Training. Drawing up plans, deadlines, methods, research tasks. Preparation of the site, equipment for the study. Formation of a group of 2 doctors, 1 nurse. The selection of representatives of different population groups, patients of different sexes should be equally.
Survey. The data is entered into the registration card without corrections, additions. Information is entered in codes indicating the presence or absence of symptoms.
Grade. The results are calculated according to the criteria (the prevalence of caries, a quantitative indicator of the incidence of periodontal disease, etc.). The results are displayed as a percentage, allowing you to form a picture of the dental health of people in the region, taking into account a list of different factors. Next, preventive measures and treatment are prescribed.

The listed hygiene indices assess the state of the oral cavity and represent a safe method of obtaining information for predictions.

Particular attention should be paid to hygienic condition of the oral cavity as a major risk factor for the development of dental diseases. An obligatory stage of the primary examination is the assessment of the hygienic state of the oral cavity by determining the hygienic indices depending on the age of the child and the pathology with which the patient applied.

Indexes proposed for evaluation of the hygienic condition of the oral cavity(hygiene index - IG) are conventionally divided into the following groups:

The 1st group of hygienic indices that evaluate the area of dental plaque includes the Fedorov-Volodkina and Green-Vermillion indices.

It is widely used to study the hygienic state of the oral cavity. Fedorov-Volodkina index. The hygienic index is determined by the intensity of the coloration of the labial surface of the six lower frontal teeth (43, 42, 41, 31, 32, 33 or 83, 82, 81, 71, 72, 73) with an iodine-iodine-potassium solution consisting of 1.0 iodine, 2 .0 potassium iodide, 4.0 distilled water. Evaluated on a five-point system and calculated by the formula:

where K cf. is the general hygienic cleaning index;

K and - hygienic index of cleaning one tooth;

n is the number of teeth.

Criteria for evaluation:

Staining of the entire surface of the crown - 5 points

Staining of 3/4 of the crown surface - 4 points.

Staining of 1/2 of the crown surface - 3 points.

Staining of 1/4 of the crown surface - 2 points.

Lack of staining - 1 point.

Normally, the hygienic index should not exceed 1.

Interpretation of results:

1.1-1.5 points - good GI;

1.6 - 2.0 - satisfactory;

2.1 - 2.5 - unsatisfactory;

2.6 - 3.4 - bad;

3.5 - 5.0 - very bad.

I.G.Green and I.R.Vermillion(1964) proposed a simplified index of oral hygiene OHI-S (Oral Hygiene Indices-Simplified). To determine OHI-S, the following tooth surfaces are examined: vestibular surfaces of 16,11, 26, 31 and lingual surfaces of 36, 46 teeth. On all surfaces, plaque is first determined, and then tartar.

Criteria for evaluation:

Plaque (DI)

0 - no plaque

1 - plaque covers 1/3 of the surface of the tooth

2 - plaque covers 2/3 of the surface of the tooth

3 - plaque covers >2/3 of the tooth surface

Tartar (CI)

0 - tartar is not detected

1 - supragingival tartar covers 1/3 of the tooth crown

2 - supragingival tartar covers 2/3 of the tooth crown; subgingival calculus in the form of separate conglomerates

3 - supragingival calculus covers 2/3 of the crown of the tooth and (or) subgingival calculus covers the cervical part of the tooth

Formula for calculation:

Formula for counting:

where S is the sum of the values; zn - plaque; zk - tartar; n is the number of teeth.

Interpretation of results:

The second group of indexes.

0 - plaque near the neck of the tooth is not detected by the probe;

1 - plaque is not visually determined, but at the tip of the probe, when it is held near the neck of the tooth, a lump of plaque is visible;

2 - plaque is visible to the eye;

3 - intensive deposition of plaque on the surfaces of the tooth and in the interdental spaces.

J.Silness (1964) and H.Loe (1967)) proposed an original index that takes into account plaque thickness. In the scoring system, a value of 2 is given to a thin layer of plaque, and 3 to a thickened one. When determining the index, the thickness of the dental plaque (without staining) is evaluated using a dental probe on 4 tooth surfaces: vestibular, lingual and two contact. Examine 6 teeth: 14, 11, 26, 31, 34, 46.

Each of the four gingival areas of the tooth is assigned a value from 0 to 3; this is the plaque index (PII) for a specific area. The values from the four regions of the tooth can be added and divided by 4 to obtain the PII for the tooth. Values for individual teeth (incisors, molars and molars) can be grouped to give PII for different groups of teeth. Finally, adding the indexes for the teeth and dividing by the number of teeth examined, the PII for the individual is obtained.

Criteria for evaluation:

0 - this value, when the gingival area of the tooth surface is really free of plaque. The accumulation of plaque is determined by passing the tip of the probe over the surface of the tooth at the gingival sulcus after the tooth has been thoroughly dried; if the soft substance does not stick to the tip of the probe, the area is considered clean;

1 - is prescribed when a plaque cannot be detected in situ with a simple eye, but the plaque becomes visible at the tip of the probe after the probe passes over the surface of the tooth at the gingival sulcus. Detection solution is not used in this study;

2 - is prescribed when the gingival area is covered with a layer of plaque from thin to moderately thick. The plaque is visible to the naked eye;

3 - intense deposition of soft matter that fills the niche formed by the gingival margin and the surface of the tooth. The interdental region is filled with soft debris.

Thus, the value of the plaque index indicates only the difference in the thickness of soft dental deposits in the gingival region and does not reflect the extent of the plaque on the tooth crown.

Formula for calculation:

a) for one tooth - summarize the values obtained during the examination of different surfaces of one tooth, divide by 4;

b) for a group of teeth - the index values for individual teeth (incisors, large and small molars) can be summarized in order to determine the hygiene index for different groups of teeth;

c) for an individual, sum the index values.

Interpretation of results:

PII-0 indicates that the gingival area of the tooth surface is completely free of plaque;

PII-1 reflects the situation when the gingival region is covered with a thin film of plaque, which is not visible, but which is made visible;

PII-2 indicates that the deposit is visible in situ;

PII-3 - about significant (1-2 mm thick) deposits of soft matter.

Tests α=2

1. The doctor stained plaque on the vestibular surface of the lower anterior teeth. What hygiene index did he determine?

A. Green-Vermillion

C. Fedorova-Volodkina

D. Tureschi

E. Shika - Asha

2. What tooth surfaces are stained when determining the Green-Vermillion index?

A. vestibular 16, 11, 26, 31, lingual 36.46

B. lingual 41, 31.46, vestibular 16.41

C. vestibular 14, 11, 26, lingual 31, 34.46

D. vestibular 11, 12, 21, 22, lingual 36, 46

E. vestibular 14, 12, 21, 24, lingual 36, 46

3. When determining the Fedorov-Volodkina index, stain:

A. vestibular surface of teeth 13, 12, 11, 21, 22, 23

B. vestibular surface of 43, 42, 41, 31, 32, 33 teeth

C. lingual surface of 43,42,41, 31, 32, 33 teeth

D. oral surface of 13,12, 11, 21, 22, 23 teeth

E. staining is not carried out

4. When determining the Silness-Loe index, the teeth are examined:

A. 16.13, 11, 31, 33, 36

B. 16,14, 11, 31, 34, 36

C. 17, 13.11, 31, 31, 33, 37

D. 17, 14, 11, 41,44,47

E. 13,12,11,31,32,33

5. Using the hygienic index Silness-Loe evaluate:

A. Plaque area

B. plaque thickness

C. microbial composition of plaque

D. amount of plaque

E. plaque density

6. To assess the hygienic condition of the oral cavity in children under 5-6 years old, the following index is used:

B. Green-Vermillion

D. Fedorova-Volodkina

7. An index is used to assess plaque and tartar:

B. Green-Vermillion

D. Fedorova-Volodkina

8. A solution consisting of 1 g of iodine, 2 g of potassium iodide, 40 ml of distilled water is:

A. Lugol's solution

B. magenta solution

C. rr Schiller-Pisarev

D. solution of methylene blue

E. solution of trioxazine

9. A good level of oral hygiene according to Fedorov-Volodkina corresponds to the following values:

10. Satisfactory level of oral hygiene according to Fedorov-Volodkina

match the values:

11. The unsatisfactory level of oral hygiene according to Fedorov-Volodkina corresponds to the values:

12. Poor oral hygiene according to Fedorov-Volodkina corresponds to the following values:

13. A very poor level of oral hygiene according to Fedorov-Volodkina corresponds to the values:

14. To determine the Fedorov-Volodkina index, stain:

A. vestibular surface of the anterior group of teeth upper jaw

B. palatal surface of the anterior group of teeth of the upper jaw

C. vestibular surface of the anterior group of teeth of the lower jaw

D. lingual surface of the anterior group of teeth of the lower jaw

E. Proximal surfaces of the anterior group of teeth of the upper jaw

15. During a preventive examination, a Fedorov-Volodkina hygiene index of 1.8 points was determined for a 7-year-old child. What level of hygiene does this indicator correspond to?

A. good hygiene index

B. poor hygiene index

C. satisfactory hygiene index

D. poor hygiene index

E. very poor hygiene index

Control questions (α=2).

1. Basic hygiene indices.

2. Methodology for determining the hygienic index of Fedorov-Volodkina, evaluation criteria, interpretation of the results.

3. Methodology for determining the hygienic index Green-Vermillion, evaluation criteria, interpretation of the results.

4. Methodology for determining the hygienic index J.Silness - H.Loe, evaluation criteria, interpretation of the results.

Target setting. Learn to determine the state of oral hygiene by the amount of plaque, tartar; methods, technical and organizational techniques, rules and manipulations necessary for the practical implementation of preventive measures.

One of the most important criteria for the state of the oral cavity in determining the level of health is the assessment of the state of oral hygiene. As the main indicator of hygiene, the determination of the amount of soft plaque, tartar and pellicle that appear on the surface of the tooth after it has erupted is used. The process of their accumulation depends on self-purification - the most important physiological function oral cavity. As an indicator of hygiene, the quantitative accounting of dental plaque is most often used - a component of the oral cavity, which depends on many factors.

Soft plaque in the oral cavity is located on the surface of the tooth, most often in the gingival area, on the border of the neck of the tooth and the edge of the gum. It has a gray or yellow-gray color and is invisible on the teeth in small quantities. However, it can be easily detected by scraping the enamel surface in the cervical region with a trowel or excavator. When accumulated, it takes the form of a soft amorphous grayish-white or grayish-yellow mass; the thickest layer of plaque is noted in the region of the gingival margin. In the place where the gums come into contact with plaque, signs of inflammation are often observed. When brushing your teeth, eating, especially hard and dense, part of the plaque from the surface of the tooth is constantly removed, but quickly re-formed. Despite being soft and loose, plaque is firmly bonded to the tooth surface.

Detection and quantification of soft plaque is based on a chemical reaction or sorption of dyes by extracellular plaque polysaccharides. Usually, Lugol's solution is used for this purpose (Kalii jodati 2.0; Jodi crist. 1.0; Aq. destill. 40.0), whose iodine stains polysaccharides in yellowish-pink tones (Fig. 16). Basic fuchsin (Fucsini bas. 1.5; Spiritus aet. 70% 25.0) is also used to stain plaque, 15 drops per 1/4 cup of rinse water, Bismarck brown, erythrosin tablets. To detect plaque, Lugol's solution is used in the form of applications with small cotton swabs dipped in Lugol's solution and applied to the surface of the teeth. Fuchsin basic stains soft plaque in a dirty red color by vigorously rinsing the mouth with a solution for 30 seconds, after which the excess dye is removed by rinsing with plain water.

The amount of plaque in the oral cavity is assessed in vivo using various semi-quantitative methods that determine the area of colored plaque on the surface of the teeth. This allows you to individually objectively assess the state of oral hygiene. In our country, the Fedorov-Volodkina index is most widely used for this purpose. It is based on a semi-quantitative (scoring) assessment of the area of the vestibular surfaces stained with Lugol's solution of the six anterior teeth of the lower jaw - incisors and canines. In this case, the staining of the entire surface of the tooth crown is estimated at 5 points, 3/4 of the surface - at 4 points, V2 - at 3 points, 1/4 - at 2 points, the absence of staining - at 1 point. Then the arithmetic mean is found by dividing the sum of the coloring of all teeth by their number according to the formula: [Кср = EKn/n] , where Кср is the hygiene index; EKn - the sum of the assessment of the examined teeth; n is the number of examined teeth. A good level of hygiene is characterized by an index of 1.0-1.3 points. The higher the index value, the lower the level of oral hygiene. Other methods for assessing oral hygiene are basically the same as described and differ in some details.

Tartar also refers to the acquired structures of the oral cavity. In small amounts, it accumulates on the lingual surfaces of the anterior teeth of the lower jaw, which is explained by the close location of the excretory ducts of the subhyoid and submandibular salivary glands. It is a mineralized structure of varying degrees of friability and strength, firmly soldered to the surface of the teeth. Its color varies from yellowish-white to gray-black, depending on the state of oral hygiene, smoking, dietary habits and other factors.
Distinguish supra- and subgingival tartar. The supragingival calculus is clearly visible during visual inspection. It accumulates on the teeth located near the orifices of the excretory ducts of the salivary glands in all people; with age, the formation of tartar increases. Subgingival calculus is usually invisible, as it is located under the gum, in the depth of the formed pathological gingival pocket. It is hard, dense, firmly connected to the root of the tooth, and therefore it is removed with great difficulty.
Quantification of supragingival calculus is based on the same principles as the oral hygiene index, but is less commonly used. It can be dyed, for example, with basic magenta.
Diagnostic dyes are also convenient to use as a test to evaluate the effectiveness of removing dental plaque. To do this, use 6% fuchsin basic for applications or 0.75% for rinsing for 20 seconds, as well as Lugol's solution and other dyes.
Soft plaque and tartar form the main part of the acquired structures on the teeth, collectively called "tartar". They are infected and can support and contribute to the development of foci of infection.
In maintaining the oral cavity in a healthy state, the removal of dental plaque is important. The technique for removing plaque is detailed in the section on oral hygiene. Removal of tartar is usually done mechanically using excavators or tools specially designed for this purpose - hooks, enamel knives, curettage spoons, etc. When removing tartar, the following rules must be observed:
1) all instruments must be sterile;
2) before removing tartar, it is necessary to perform antiseptic treatment of the surgical field with a 3% solution of hydrogen peroxide and iodine. For isolation from saliva, use cotton rolls or gauze;
3) the hand holding the excavator or other tool for removing dental plaque should be fixed on the patient's chin or adjacent teeth, which prevents damage to soft tissues;
4) mobile teeth are fixed with the fingers of the left hand;
5) after removing deposits, the oral cavity is treated with antiseptic solutions (iodine, 2-3% hydrogen peroxide solution). When working with a doctor who removes dental plaque, you need to protect your eyes with special glasses.
For thorough removal of tartar from all teeth, the correct position of the patient is important: the level of the chair and the position of the head vary depending on the group of teeth being treated.
Removal of tartar is recommended to be completed by polishing the surface of the root. This procedure is performed using special rubber cups, polishers, wooden sticks. For polishing, use a paste (10 g of pumice, 10 g of glycerin and 5 drops of iodine) or chalk mixed with hydrogen peroxide.
When removing a stone, a certain sequence is usually followed. For example, first the stone is removed from the buccal, then from the lingual surfaces, then from the interdental spaces. Subgingival calculus and granulations are recommended to be removed from no more than 5-6 teeth at a time, based on the rule that the quality of removal plays a paramount role. Removal of subgingival calculus is controlled by a probe. If roughness is felt when sliding along the surface of the root, this indicates that it is not completely removed and the manipulation should be repeated.