3 - dislocation. Requires professional intervention.

4 - pain in the joint area. Pain in the TMJ or other area of ​​the head, neck, or shoulder area associated with TMJ dysfunction.

Need for emergency care

The investigator, based on his clinical experience, decides whether immediate treatment is necessary. To register the presence of such conditions (code 1), there are cells 115-117:

condition, life threatening(crayfish oral cavity or a precancerous lesion, or other serious condition with a pronounced manifestation in the oral cavity), - cell 115,

jaw fracture - cell 116,

pain or inflammatory process that requires urgent intervention is cell 117.

If the subject is referred to a medical facility for care, code 1 should be entered in box 118.

The states encoded in boxes 115-118 are not mutually exclusive; if there is more than one condition that requires immediate assistance, multiple entries can be made in the map.

Other states

The investigator must indicate any condition recorded in boxes 119-120 and recalculate the codes used in the survey summary sheet.

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

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 to the total number of those examined (calculated as a percentage):

number of children with caries x 100

Prevalence of caries = - .

number of examined children

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

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

Morbidity (increase in the intensity of caries) 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.

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.

Evaluate the effectiveness of preventive measures allows the reduction of caries (in percent).

For example, in the control group, an increase in the intensity of caries after one year is 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%.

Chapter 6

Oral hygiene is one of the sections of personal hygiene. Like any hygiene, it is aimed at maintaining health and preventing diseases.

Although the bulk of the substances entering the body lingers in the oral cavity during the act of chewing for only a few tens of seconds, nevertheless, this produces a certain effect on its tissues and organs. Its essence may lie in the dissolution of tooth enamel under the influence of various mineral and organic acids, food and drink chelates, in the action of chemical and mechanical irritants on the oral mucosa, and in the contamination of it with various microorganisms. The chemical and mechanical effects of substances coming from outside, when some of them are retained in the mouth for one reason or another, can be very long. Irregularities in the relief of the mucous membrane, the presence of interdental spaces, as well as periodontal pockets - all this contributes to the retention of food debris in the oral cavity and favors the reproduction of microorganisms. During life, about 30,000 liters of saliva is poured into the human oral cavity, which includes enzymes and other biologically active substances. active substances. The action of saliva is aimed at dissolving and washing away food and liquid residues. Saliva has both positive (bactericidal, remineralizing, trophic) and negative (increased mucosal permeability, increased leukocyte migration) effects.

The cleansing action of saliva in many cases is not effective enough. This is due to the fact that the nature of the diet of modern man is significantly different from the diet of his distant ancestors. As a rule, civilization provides a person with refined, thermally processed and physically ground food, rich in proteins and easily soluble carbohydrates, which are a good breeding ground for microbes. In addition, the food of modern man contains little natural bactericidal substances and some vitamins, in particular ascorbic acid and tocopherol. Exclusion from the diet of raw plant foods prevents mechanical cleansing oral cavity and does not increase its bactericidal potential.

Thus, in the oral cavity of a modern person, favorable conditions are created for the active development of microorganisms, products

with pathology salivary glands. In healthy people, about 7-8 mg of lysozyme per day enters the oral cavity with mixed saliva. Approximately 1.5 mg of this enzyme comes with emigrating neutrophilic granulocytes.

Two ribonucleases were found in human saliva: acidic and alkaline, as well as DNase. These enzymes are credited with not only antibacterial, but also antiviral action. The mechanism of the antimicrobial action of nucleases is the depolymerization of the nucleic acids of microorganisms, which causes them to lose their ability to reproduce. The main source of DNase in the oral cavity is the parotid salivary glands.

Along with enzymes, an important place in the antimicrobial protection of the oral cavity is occupied by immunoglobulins (antibodies), up to 250 mg of which are secreted by the salivary glands daily. Human saliva contains the most class A immunoglobulins (80-90% of all antibodies), significantly less class G immunoglobulins, and practically no class L and M immunoglobulins. Immunoglobulins A include antibodies that specifically interact with virus antibodies, bacteria, fungi and bacterial toxins. They cause agglutination of streptococci in the oral cavity, thereby preventing the formation of plaque. In addition, these immunoglobulins inhibit the aggressive enzymes hyaluronidase and neuraminidase, which are produced by cariogenic streptococci. The antimicrobial action of immunoglobulins F is enhanced under the influence of lysozyme.

The most important element of antimicrobial protection of the oral cavity are emigrating leukocytes. Emigration of leukocytes occurs under the influence of a number of chemotoxic factors of saliva: leukotoxin, oxidase, kallikrein. Plaque chemotoxic factors play a particularly important role.

The granules contained in neutrophilic granulocytes are a source of a large number of bactericidal substances of an enzymatic and non-enzymatic nature. These substances are released into the oral cavity both by secretion and as a result of the destruction of emigrated neutrophilic granulocytes. Lymphocytes also secrete antibacterial substances - lymphokines and immunoglobulins.

The biocenosis of the oral cavity, which has developed as a result of a long-term interaction of microorganisms and the physiological systems of the macroorganism, as well as due to various social and hygienic factors, is the most important condition for the existence of the human body. An excessive deviation from the optimal status of the biocenosis of the oral cavity can lead to the development of a pathological process. Thus, an excess of microflora in the oral cavity contributes to the development of bacterial intoxication and

whose vital activity (toxins, enzymes, allergens) cause pathological processes in periodontal tissues and tooth enamel. Some of the waste products of microorganisms have an unpleasant odor and thus cause halitosis.

Removal of food debris. This is achieved by mechanical cleaning of the teeth with a toothbrush, toothpick, dental floss, as well as the use of surfactant solutions. AT last years for these purposes, preparations of food enzymes are used, which cause the hydrolysis of proteins, carbohydrates, lipids of food residues. Usually, pancreatin (acetone or lyophilized pancreas powder) and especially preparations of enzymes of microbial origin are used for this. The faster the breakdown of food debris, the less food remains for microorganisms in the oral cavity.

Suppression of excessive multiplication of microbes in the oral cavity In the oral cavity there are several dozen types of microorganisms - from viruses to protozoa. Among them there are anaerobes and aerobes, parasites and saprophytes. Factors contributing to the reproduction of microorganisms are: sufficient hydration of the oral cavity, the presence of nutrients (readily soluble carbohydrates and proteins), optimal physical environmental conditions. The bactericidal substances of saliva, antimicrobial food factors, microbial antagonism, and the removal of food debris prevent the reproduction of microorganisms.

There are several antimicrobial systems in human saliva: enzymatic, immunoglobulin, low molecular weight, cellular. Antimicrobial enzymes of saliva include: lysozyme - an enzyme of the class of hydrolysis, peroxidase and DNase. These enzymes are produced in the large salivary glands, mainly in the parotid. Lysozyme is a relatively small protein, consisting of 129 food amino acid residues and having an isoelectric point in the alkaline region (about pH 10). The primary, secondary and tertiary structures of lysozyme are now completely deciphered. The physiological function of lysozyme is its antibacterial action. The enzyme lyses Gram-positive bacteria of the Sarcin genus (Micrococcus Lyzodeikticus, Bacteria Megaterium, etc.). A number of microorganisms (Escherichia coli, Salmonella typhy) are lysed by lysocine only after preliminary heating or exposure to the antibody-complement complex.

Inflammatory phenomena of the tissues of the oral cavity (gingivitis, periodontitis, stomatitis), as a rule, are accompanied by a decrease in the activity of lysozyme. An even greater decrease in lysozyme activity is observed

allergization, and its lack, especially saprophytic, creates favorable conditions for the reproduction of pathogenic microorganisms.

Most often, there is an insufficiency of antimicrobial systems of the oral cavity, which leads to the overdevelopment of microorganisms. Therefore, the role of hygiene products is to suppress the overgrowth of microbes and to stimulate antimicrobial systems. For these purposes, antibiotics, bactericidal substances, enzymes, and their various compositions are introduced into the composition of hygiene products.

Prevention of formation and dissolution of plaque. As already mentioned, plaque is a kind of colony of microorganisms distributed in a supporting medium from dextran and levan. Of the many microbes that live in the oral cavity, there are several species that have a pronounced ability to form plaque. These are microorganisms such as str. mutans, Actinomycetus viscosus, etc. Suppression of the growth of these microbes by immunization, the introduction of appropriate bacteriophages or special antibiotics can be very effective in preventing the formation of plaque.

The interaction of microbes with the enamel surface is facilitated after the treatment of cell membrane glycoproteins with neurominidase, which, in the presence of calcium and phosphorus ions, cleaves off the remains of sialic acids, as well as specific salivary agglutinogens. The formation of plaque is impossible without the formation of extracellular polysaccharides such as dextran, which have adhesive properties. Dextran is formed from sucrose, so limiting sugar intake is an indispensable condition for preventing the formation of plaque. Some microorganisms produce a special enzyme, dextranase, that can break down dextran and thereby dissolve plaque.

Most effective method plaque removal - mechanical cleaning of teeth with a toothbrush. Efficiency mechanical cleaning increases significantly when using tooth powders or toothpastes.

Strengthening the processes of enamel remineralization. Enamel remineralization is one of the most significant mechanisms in maintaining its anatomical integrity and structural and functional activity.

Although the laying of milk and a significant part of permanent teeth occurs in the antenatal period, their resistance to the action of environmental factors is determined by the conditions in which it proceeded. The process of maturation of enamel occurs for another 3-5 years after teething. In general, the period of maturation of tooth enamel is completed by the age of 12-15. This is a very important circumstance, since during this period, with the help of

schyu rational complex therapeutic preventive measures it is possible to positively influence the process of enamel maturation, create conditions for the formation of its high structural resistance.

Teething with immature, not yet completely formed enamel is biologically justified, since saliva is a sharply (much more than blood) liquid supersaturated with calcium and phosphorus, which contributes to the final maturation of the enamel and the formation of special properties of its surface layer.

Magnesium and fluorine ions have a positive effect on enamel mineralization. The process of remineralization in the enamel can be judged by the intensity of penetration of radioactive phosphorus into the teeth from the oral cavity. Brushing teeth with various toothpastes enhances enamel remineralization, and to the greatest extent enhances the incorporation of phosphorus into the teeth under the influence of toothpaste containing dicalcium phosphate and the enzyme alkaline phosphatase.

Under the influence of toothpastes, the remineralization of the alveolar process also changes. mandible. It has the strongest remineralizing effect toothpaste, made on the basis of aerosil, containing the enzymes lysozyme and ribonuclease and sodium fluoride (toothpaste "Crystal"). Long cleaning toothpastes containing biologically active substances, leads to an increase in the content of calcium in the alveolar process and, to a lesser extent, phosphorus.

Despite the fact that there are quite a few hygiene products containing calcium, phosphorus and fluorine ions, the optimal concentrations and ratios of these ions have not yet been scientifically substantiated, the effect of magnesium ions and microelements on the remineralization process has not been thoroughly studied. The lack of such data hinders the development of specialized hygiene products designed to enhance remineralization processes.

Influence biologically active components on the metabolic processes occurring in the tissues of the oral cavity. Biologically active components contained in oral hygiene products, being absorbed into the mucous membrane, have a certain effect on the metabolic processes occurring in it. The ability of individual biologically active components to have a normalizing effect on metabolic disorders in the oral mucosa and increase its structural resistance in stomatitis has been well proven.

After brushing your teeth with various enzyme-containing pastes, lysozyme and RNA-ates, which have a small molecular weight, are best absorbed. These same enzymes are most of all absorbed from the oral cavity into the bloodstream.

Biologically active substances penetrating into periodontal tissues primarily affect the state of proteins and, in particular, collagen, the main component of connective tissue. The content of collagen is closely correlated with the level of hydroxyproline. Brushing teeth with pastes containing bioactive substances leads to an increase in the concentration of protein in periodontal tissues and the content of hydroxyproline in the protein. Under the influence of brushing teeth with therapeutic and prophylactic pastes, there is an increase in protein biosynthesis in the gum tissues. Brushing teeth with vitamin-containing toothpastes leads to a significant increase in the concentration of vitamins in the gum tissue.

Influence of oral hygiene products on the functional activity of the salivary glands. The importance of the salivary glands for the state of the organs and tissues of the oral cavity is well known. In addition, they also affect the underlying sections of the digestive apparatus, primarily the stomach. Therefore, the state of the enzyme-excretory function of the salivary glands during oral hygiene measures is one of the elements of the mechanism of the therapeutic and prophylactic action of toothpastes and elixirs. The introduction of fluorides into the oral cavity causes the activation of alkaline phosphatase in saliva and inhibition of the activity of 1-amylase in the parotid glands.

Brushing teeth with toothpastes has a modifying effect on the functional activity of the salivary glands: the pH of saliva and its protein content change. The qualitative characteristics of the recorded shifts depend both on the type of abrasive and on the biologically active component contained in the paste. The reaction of the salivary glands to the use of a hygiene product is highly individual.

There was a real opportunity to select the most appropriate hygiene product, taking into account the state of the oral cavity and the reaction of the salivary glands.

Deodorizing effect of hygiene products. Even before the development of scientific ideas about the effect of hygiene measures on the oral cavity, the ability of hygiene products to eliminate halitosis and give a feeling of pleasant freshness was widely used. This was achieved by introducing various aromatic and fragrant substances into the hygiene products, which “interrupted” the bad smell that arises from the breakdown of amino acids and other organic compounds and is caused by the action of microorganisms.

Anti-inflammatory effect of oral hygiene products Most dental hygiene products contain extracts of medicinal plants that have a wide range of therapeutic effects.

(analgesic, anti-inflammatory, regenerating, antimicrobial, etc.).

Dental elixirs containing various extracts have a pronounced anti-inflammatory effect, reducing swelling of the oral mucosa by almost 1.5 times. A similar effect is observed when using toothpastes, including extracts medicinal plants.

Regular use of dental hygiene products containing extracts of medicinal plants helps to prevent inflammation in periodontal tissues and oral mucosa.

Characteristics of dental deposits.

On the surface of the tooth there are various structural formations: cuticle, pellicle, plaque (plaque), tartar.

1. Non-mineralized dental deposits;

a) pellicle;

b) dental plaque;

c) white matter (soft plaque);

d) food leftovers.

2. Mineralized dental deposits;

a) supragingival tartar;

b) subgingival tartar.

After eruption, as the tooth loses embryonic formations, the surface of the enamel is exposed to saliva and microorganisms. The cuticle, or reduced enamel epithelium, is lost before or shortly after tooth eruption and, therefore, does not play a significant role in the physiology of the tooth in the future. A pellicle forms on the surface of a tooth after it has erupted. The origin of the pellicle has not been definitively established. The pellicle has three layers, two of which are located on the surface of the enamel, and the third is in the surface layer. The thickness of the daily pellicle is 2-4 microns. The organic composition of the pellicle is a mixture of salivary proteins and components of lysed bacteria. In many places, the pellicle of the tooth is covered with a layer of plaque. After removal with abrasive substances, the pellicle is quickly restored when the tooth comes into contact with saliva. The processes of diffusion and permeability in the surface layer of enamel depend on the state of the pellicle.

Dental plaque is located above the pellicle of the tooth; staining solutions are used to detect it. dental plaque sticks firmly to the surface underneath, from which it can be peeled off

The opinion that spoiled teeth is a disease only of modern people is wrong.

Caries is widespread even during the Neolithic. Since then, medicine has continued to fight the disease.

Prevalence and intensity are the main indicators of carious lesions.

It is important to clearly know how these indicators are calculated, on what they depend.

Importance of problem research

The study of the etiology and pathology of caries is still one of the top priorities modern dentists, because statistics allow us to draw conclusions about the successes in the fight against the disease and develop new preventive measures.

Analytical indicators of carious lesions are necessary for:

• deep learning etiology and pathogenesis;
• holding population differentiation by the nature of the risk of the disease;
• development preventive measures;
• estimates existing preventive methods, their effectiveness;
• assessing the relevance of carious pathologies for certain groups of people.

When calculating, experts rely on odds obtained within the scales:

1. person;
2. tooth
3. tooth surface;
4. the focus of the disease.

The following criteria are used to evaluate the process: prevalence and intensity.

Prevalence and intensity of caries

According to statistics, not even the inhabitants were spared from dental diseases. underdeveloped countries nor those who inhabit modern megacities where the latest achievements of science and medicine are present. Even in developed centers, the prevalence rate does not drop below the figure of 77%. This is the case in industrial Western European and American cities. Here, this figure reaches 95% .

Photo 1. Indicators of the prevalence of caries in Russia, taking into account the age of the examined. According to statistics, after 35 years, almost every resident of the country has problems with teeth.

In pre-war Europe, according to statistics, caries suffered almost 100% population: 97% all residents children's age and 98% youth.

Despite the fact that caries does not make any difference in age, scientists have come to the conclusion that this disease is still characteristic predominantly to young people. The older the study group, the higher the prevalence and intensity.

In Russia, caries is common 100%: every adult Russian needs the help of dentists to varying degrees.

The favorite target of pathogenic bacteria is natural depressions and irregularities on the surface of the tooth, also places that are difficult to completely clean with a brush: fissures, necks, interdental spaces, the so-called blind pits.

Important! The upper jaw suffers to a greater extent than the lower one, and from above they take the main blow anterior teeth, and below - chewing and root.

There is also no gender difference for bacteria: both men and women equally need fillings.

Index as an indicator of the degree of development of the disease

When assessing the intensity of lesions using a special caries index. This is an indicator of the degree of development of the disease each individual person. Approach to adults and children different:

• the total number of teeth removed, filled and in need of treatment - for the adult population;
• the total number of cured and untreated teeth - in children.

The index of prevalence and intensity among the studied population is determined according to certain rules. Calculate first individual index each member of the group, and then calculate average.

Photo 2. To obtain statistical data, the dentist examines each individual participant and fixes the problems identified in him.

Prevalence is low up to thirty percent, the average reaches and eighty, and high and one hundred percent.

When determining the intensity, experts rely on the following indices:

1. Intensity of lesions milk teeth. Two indicators are used here: KP (s) and KP (p) - the amount cured and needy in fillings of teeth and surfaces, respectively. The calculation principle is the same here: they determine the indicators for each representative of the group, add all the numbers together and then divide by the number of subjects.
2. Intensity of lesions permanent teeth. These are the CPU(s) indices - here we are talking about the amount in need of treatment, cured and torn out teeth in humans and CPU (n). The latter implies the sum of all surfaces that need treatment or on which there are seals. A pulled tooth counts as five surfaces.

Reference. Neglected in the calculation early forms of the disease(spot stage, superficial caries). Therefore, specialists are critical of the existing system of statistics, because it represents a more optimistic picture than what is actually there.

Practice shows that in Russian realities people suffer from caries all ages, just in children and adolescents are most often diagnosed early forms, which, being noticed in time, successfully liquidated.

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Growth rate

Speaking of statistics, also rely on growth index. This indicator is calculated from the difference between the KPU indices for a certain observation period - six months to several years.

The lower bound is by default year: during this time, new foci develop in an ordinary citizen who is considered healthy.

Applied to people suffering from various pathologies internal organs, as well as especially rapidly developing carious lesions, establish period of six months.

Definition of reduction

Growth reduction points to percentage difference for two identical quantities. Usually, the increase in the intensity of lesions of the tooth surface in representatives of the preventive and control groups is compared.

Epidemiology indicators

Modern scientists have no doubt that caries takes first place in popularity among diseases. Even in developed countries nine out of ten people the mouth needs sanitation. Over time, the size of the teeth and their shape change, as well as the resistance of the enamel to internal and external threats.

Photo 3. The dentist conducts a preventive examination of a small patient in order to identify and treat caries on early stages.

Experts note that with the development scientific and technological progress natural protection of tooth enamel weakens, this is also due to numerous additives in modern nutrition , and with ecology, and with harmful conditions labor in which a huge number of people are forced to work. With the achievements of science, nature and man himself are changing, but environment is changing much faster how people can adapt to it. Tooth enamel simply does not have time to develop enough to acquire proper stability.

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 latest methods treatment and diagnosis. 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 medical card up to 75 years old. 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.

Domestic 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 from 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%.
• Average – 31-80%.
• High – 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(z) 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 shortage useful substances in the body, weakening 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 preventive and hygienic means is effective method prevention of 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.

Carious process - a disease that affects dental tissues, characterized by their destruction with the formation of cavities. AT modern world Everyone has met him at least once. The disease is widespread due to an unbalanced diet. a large number 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 treatment 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 difficult, it is necessary to explain more and more plain 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 the 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.

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In 1981, the WHO set a goal: to reduce the intensity of caries in 12-year-old children to CPV=3. In 20 years, about 70% of the world's countries have achieved this goal. However, the low intensity of dental caries in the population as a whole does not exclude the high intensity of caries in a part of the population. In recent years, the "dental inequality" has become more and more noticeable: while a significant part of the population remains free from caries, the brunt of dental caries falls on the least protected minority of the population. In 2000, Brathole introduced the Significant Caries Index (SiC) to draw attention to disadvantaged populations in pursuit of the WHO strategic goal of Health for All. This index is an average IPC calculated for a third of the surveyed population, which has the highest IPC index for this population (Fig. 5.9).

Rice. 5.9. An example of preparing epidemiological survey data for calculating the SiC index.

In Figure 5.9, the data from the epidemiological survey are presented as a graph of the frequency distribution of the IPC. Approximately 45% of the members of the population are free from caries (CWH=0). The mean CVAC for the entire population is 1.91. The vertical line shows the selection of the subgroup for which SiC was calculated. This indicator of caries intensity turned out to be much higher: SiC=4.61.

A new global target for improved dental health by 2015 has been formulated: achieving SiC levels
Indicators of the intensity of dental caries make it possible to determine the form of the course (degree of activity) of caries (T.F. Vinogradova). CVUS values ​​(CVUS + CVUS) that do not exceed the average values ​​of these indicators for a given age group (CVUS=M) are regarded as an indicator of a compensated course of caries. To calculate the boundaries of the CPUS for the subcompensated and decompensated course of caries, the statistical value a is used - the standard deviation:

b = (KPUSmax - KPUSmin)/K

The boundaries of the subcompensated course of caries have been determined: in this group, the value of CVUS exceeds the average value of M, but does not go beyond the boundaries of the value equal to M + 30 (M
In the case of decompensated caries, CPUS exceeds the value equal to M+30 (CPUS>M+Sb).

The form of the course of dental caries in a school-age child can be determined using the table (see Table 5.4), the data of which are calculated using these formulas based on the results of an epidemiological survey of Moscow schoolchildren conducted in the 1970s and 1980s.

Table 5.4. Forms of the course of caries in children

The change in indicators of CPUS over time is defined as an increase in the intensity of caries. The increase in the intensity of dental caries AKPUZ is calculated as the difference between the final and initial values ​​​​of the CIPUZ index:

LKPUZ = KPU32-KPU31,

Where KPU32 is registered after some time (a year, two or more) after the registration of KPUZ,.

In one person or in a group with the same composition, CPSS may remain unchanged or increase over time. The increase may be more or less pronounced depending on a number of conditions, including the nature of the preventive measures taken during the observation period.

The concept of the growth of CPUS underlies the scale for determining the level of intensity of dental caries PEC (P. ALeus). The individual PIC is calculated as the quotient of the CVUS (kpuz) and the number of years lived by the patient (N), i.e. average annual growth of CPSU:

PEC=CPU/N

When calculating the PEC of permanent teeth in children aged 9-19, the first 5 years of life are not taken into account, i.e. Years before permanent teeth erupt:

PEC=CPU/(N-5)

Table 5.5. Evaluation of caries activity according to the values ​​of PEC

Table 5.6. Caries activity at different values ​​of CVUS (CVUS+cvs, cvs) in different age groups

An example of calculating the reduction in the increase in the intensity of caries.

Before the introduction of the preventive program in 6"A" class KPUZA = 2.8; in 6"B" - KPUZB1 = 3.0. Then for two years in the 6th "A" class, oral hygiene lessons were conducted, in the 6th "B" - lessons in hygiene and application of fluorine varnish. After two years of the preventive program:
. in 6"A" class - KPUZA2 = 4.8;
. in 6"B" class - KPUZB2 = 4.5.
. increase in AKPU32_, in 6 "A" class: KPUZA2 - KPUZA1 \u003d 4.8-2.8 \u003d 2.0.
. increase in DKPU32_, in 6"B" class: KPUZB2 - KPUZB1 \u003d 4.5-3.0 \u003d 1.5.

Estimation of the growth of caries in 6"B" class compared with the growth of caries in 6"A":
2.0 (AKPUZ 6A) - 100%; 1.5 (AKPU3 6B) -x%; according to the properties of proportion:

X \u003d (1.5 / 2) * 100 \u003d 75%.

Reduction \u003d 100% - ((AKPUZprof) / (AKPUZkontr)) * 100%

USP = 100% - ((K+A)/KPUZ)*100%

Values ​​for SLR are interpreted as follows: SLR less than 10% corresponds to a poor level of dental care; USP from 10 to 49% - insufficient level, from 50 to 79% - satisfactory, over 80% - good level availability of therapeutic and orthopedic care.

Intensity of caries of tooth surfaces

Rice. 5.10. Schematic representation of the molar and premolar (a), canine and incisor (b).

Often a carious lesion of one surface extends to adjacent surfaces of the tooth. It is customary to consider as damaged only one, the main surface, until the damage to the adjacent surface exceeds more than 1/3 of its area.

The value of CPMC (permanent teeth) can range from 0 to 128; klub (temporary teeth) - from 0 to 88.

Calculate the individual and group CPMC (CPMC + kpup, kpup), its growth and reduction.

Recording and counting the intensity of surface caries is technically more difficult, so this indicator has a lower reproducibility1 than ICPU. On the other hand, this indicator is more sensitive, which makes it possible to distinguish between the effectiveness and mechanisms of action. various means and methods of prevention. Thus, the reduction in the intensity of dental caries under the influence of water fluoridation for the chewing surface is 20%, for the remaining surfaces of the teeth - 80%.

Accounting for carious foci

T.V. Popruzhenko, T.N. Terekhova