Teeth staining with Pisarev's Schiller's solution. Signs of inflammation of the gums

The diagnostic value of the test is the appearance of glycogen in the gums with pathological changes of an inflammatory nature in children older than 3 years.

The technique consists in lubricating the gingival margin Schiller's solution:

Crystalline iodine 1.0

Potassium iodide 2.0

Distilled water 40.0

Lugol's solution:

Crystalline iodine 1.0

Potassium iodide 2.0

Distilled water 50.0

RMA index- papillary-marginal-alveolar index is used to determine the localization of inflammation and its intensity. The technique consists in lubricating the gingival margin (papillary, marginal, alveolar gums) with an iodine-containing solution (Lugol's solution, Schiller's solution).

The color of the papilla is estimated as 1 point (P), the color of the gingival margin (M) - 2 points, the color of the alveolar gum (A) - 3 points.

In the Parma modification:

RMA index =

Interpretation:

The periodontium is a complex of tissues that have a genetic and functional commonality: periodontium, alveolar bone, gums with periosteum and tooth tissues (cement, enamel).

The depth of the periodontal sulcus is usually 0.5 to 2.0 mm. Its base is located at the site of the intact connection of the epithelium with the tooth. Clinically, the gingival sulcus is a gap between a healthy gum and the surface of the tooth, which is detected with careful probing.

Periodontitis is an inflammation of the periodontal tissues, characterized by progressive destruction of the periodontium and bone. The etiological factor is dental deposits. Local causes of artificial origin: - crown. Deeply advanced under the gum or improperly made. Protruding edges of seals.

The pathogenesis of the action of local factors:

MN → gingivitis → GK formation → formation of an abnormal periodontal pocket → tooth mobility → tooth extraction.

If the dentogingival connection is disturbed, an abnormal periodontal pocket is formed, the probing depth is more than 3 mm.

Complex periodontal index KPI (Leus P.I.) represents the average value of signs of periodontal damage from risk factors to the advanced stage of the disease.

KPI formula = The sum of signs (codes)

where: n is the number of examined sextants (one tooth from each sextant, usually 6).

KPI average = The amount of KPI individual

Number of persons examined

Technique: soft plaque, bleeding of the gingival sulcus, subgingival tartar, pathological periodontal pockets and pathological tooth mobility are visually determined using an angular probe, and, if there is a sign, they are recorded digitally according to the following scheme:

If there are signs, the existing larger code value is recorded.

Depending on age, the following teeth are examined:

3 - 4 years 55, 51, 65,75,71,85.

7 - 14 years 16, 11, 26, 36, 31.46.

15 years and older 17/16, 11, 26/27, 37/36, 31, 46/47.

In this case, we examine 10 teeth out of 6 sextants. Of the two adjacent molars, we select the one with the largest code to calculate the index. A tooth with a smaller code is not taken into account, as a result, 6 teeth are left for calculating the index.

INTERPRETATION

Notes:

In the absence of the first molar, we examine only the second molar and vice versa.

In the absence of both 6 and 7, then 5→8→4.

If all teeth are missing in the sextant, then this is most often a consequence of periodontitis (mobility) and this sextant is evaluated with code 5 to calculate the index.

In the presence of crowns on the teeth, nearby teeth are examined within the sextant.

If there are crowns on all the teeth in the sextant, then the teeth with crowns are examined.

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

In persons under 20 years old, 6 teeth are examined: 16, 11, 26, 36, 31, 46; over 20 years old: 17/16, 11, 26/27, 37/36, 31, 46/47.

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

Index codes and criteriaCPITN:

Code 0 - healthy tissue

Code 1 - bleeding during probing

Code 2 - Tartar

Code 3 - PZDK 4-5 mm

Code 4 - PZDK 6 mm or more

The examination is carried out using a periodontal bellied probe. Recommended areas for probing are: medial, middle and distal areas, both on the vestibular, and on the lingual and palatal surfaces.

To determine the need for treatment of periodontal disease, patients can be assigned to the appropriate categories based on the following criteria:

0 - there is no need to treat this patient;

1 - it is necessary to improve oral hygiene;

2 - improvement of oral hygiene, professional hygiene;

3 - improvement of oral hygiene, professional hygiene, curettage;

4 - improvement of oral hygiene, professional hygiene, deep curettage, patchwork operations, orthopedic treatment.

irreversible and complex. At help of reversible indices evaluate the dynamics of periodontal disease, the effectiveness of therapeutic measures. These indices characterize the severity of such symptoms as inflammation and bleeding of the gums, tooth mobility, the depth of gum and periodontal pockets. The most common of them are the PMA index, Russell's periodontal index, etc. Hygienic indices (Fedorov-Volodkina, Green-Vermilion, Ramfjord, etc.) can also be included in this group.

Irreversible indices: radiographic index, gingival recession index, etc. - characterize the severity of such symptoms of periodontal disease as resorption of the bone tissue of the alveolar process, gum atrophy.

With the help of complex periodontal indices, a comprehensive assessment of the state of periodontal tissues is given. For example, when calculating the Komrke index, the PMA index, the depth of periodontal pockets, the degree of atrophy of the gingival margin, bleeding gums, the degree of tooth mobility, and the Svrakoff iodine number are taken into account.

Oral hygiene index

To assess the hygienic state of the oral cavity, the hygiene index is determined according to the method of Yu.A. Fedorov and V.V. Volodkina. As a test for hygienic cleaning of teeth, the coloring of the labial surface of the six lower front teeth with an iodine-iodide-potassium solution (potassium iodide - 2 g; crystalline iodine - 1 g; distilled water - 40 ml) is used.

Quantitative assessment is carried out according to a five-point system:

staining of the entire surface of the tooth crown - 5 points;

staining of 3/4 of the surface of the tooth crown - 4 points;

staining of 1/2 of the surface of the tooth crown - 3 points;

staining of 1/4 of the surface of the tooth crown - 2 points;

lack of staining of the surface of the tooth crown - 1 point.

By dividing the sum of points by the number of teeth examined, an indicator of oral hygiene (hygiene index - IG) is obtained.

The calculation is made according to the formula:

IG = Ki (sum of scores for each tooth) / n

where: IG - general cleaning index; Ki - hygienic index of cleaning one tooth;

n is the number of examined teeth [usually 6].

The quality of oral hygiene is assessed as follows:

good IG - 1.1 - 1.5 points;

satisfactory IG - 1, 6 - 2.0 points;

unsatisfactory IG - 2.1 - 2.5 points;

poor IG - 2.6 - 3.4 points;

very poor IG - 3.5 - 5.0 points.

With regular and proper oral care, the hygiene index is in the range of 1.1–1.6 points; an IG value of 2.6 or more points indicates a lack of regular dental care.

This index is quite simple and accessible for use in any conditions, including when conducting mass surveys of the population. It can also serve to illustrate the quality of cleaning teeth in hygiene education. Its calculation is carried out quickly, with sufficient information content for conclusions about the quality of dental care.

Simplified hygienic index OHI-s [Greene, Vermilion, 1969]

6 adjacent teeth or 1–2 from different groups (large and small molars, incisors) of the lower and upper jaws are examined; their vestibular and oral surfaces.

1/3 of the surface of the tooth crown - 1

1/2 surface of the crown of the tooth - 2

2/3 of the surface of the crown of the tooth - 3

lack of plaque - 0

If the plaque on the surface of the teeth is uneven, then it is estimated by a larger volume or, for accuracy, the arithmetic mean of 2 or 4 surfaces is taken.

OHI-s = Sum of indicators / 6

OHI-s = 1 reflects the norm or ideal hygienic state;

OHI-s > 1 - poor hygienic condition.

Papillary Marginal Alveolar Index (PMA)

Papillary-marginal-alveolar index (PMA) allows you to judge the extent and severity of gingivitis. The index can be expressed in absolute figures or as a percentage.

The evaluation of the inflammatory process is carried out as follows:

inflammation of the papilla - 1 point;

inflammation of the gingival margin - 2 points;

inflammation of the alveolar gums - 3 points.

Assess the condition of the gums for each tooth.

The index is calculated using the following formula:

PMA \u003d Sum of indicators in points x 100 / 3 x the number of teeth in the subject

where 3 is the averaging coefficient.

The number of teeth with the integrity of the dentition depends on the age of the subject: 6–11 years old - 24 teeth; 12-14 years - 28 teeth; 15 years and older - 30 teeth. When teeth are lost, they are based on their actual presence.

The value of the index with a limited prevalence of the pathological process reaches 25%; with pronounced prevalence and intensity of the pathological process, the indicators approach 50%, and with further spread of the pathological process and an increase in its severity, from 51% or more.

Determination of the numerical value of the Schiller-Pisarev test

To determine the depth of the inflammatory process, L. Svrakov and Yu. Pisarev suggested lubricating the mucous membrane with iodine-iodide-potassium solution. Staining occurs in areas of deep damage to the connective tissue. This is due to the accumulation of a large amount of glycogen in areas of inflammation. The test is quite sensitive and objective. When the inflammatory process subsides or stops, the color intensity and its area decrease.

When examining a patient, the gums are lubricated with the indicated solution. The degree of coloration is determined and areas of intense darkening of the gums are fixed in the examination map, for objectification it can be expressed in numbers (points): coloring of the gingival papillae - 2 points, coloring of the gingival margin - 4 points, coloring of the alveolar gums - 8 points. The total score is divided by the number of teeth in which the study was conducted (usually 6):

Iodine value = Sum of scores for each tooth / Number of teeth examined

mild process of inflammation - up to 2.3 points;

moderately pronounced process of inflammation - 2.3-5.0 points;

intense inflammatory process - 5.1-8.0 points.

Schiller-Pisarev test

To characterize inflammation, the following gradation was adopted:

- staining of the gums in a straw-yellow color - a negative test;

- staining of the mucous membrane in a light brown color - a weakly positive test;

– staining in dark brown color – a positive test.

In some cases, the test is applied with the simultaneous use of a stomatoscope (20 times magnification). The Schiller-Pisarev test is carried out for periodontal diseases before and after treatment; it is not specific, however, if other tests are not possible, it can serve as a relative indicator of the dynamics of the inflammatory process during treatment.

Periodontal index

The following ratings are used:

no changes and inflammation - 0;

mild gingivitis (inflammation of the gums does not cover the tooth

from all sides) - 1;

gingivitis without damage to the attached epithelium (clinical

pocket is not defined) – 2;

gingivitis with the formation of a clinical pocket, dysfunction

no, the tooth is immobile - 6;

severe destruction of all periodontal tissues, the tooth is mobile,

can be shifted - 8.

The periodontal condition of each existing tooth is assessed - from 0 to 8, taking into account the degree of gingival inflammation, tooth mobility and the depth of the clinical pocket. In doubtful cases, the highest possible rating is given. If an X-ray examination of the periodontium is possible, a score of "4" is introduced, in which the leading sign is the condition of the bone tissue, manifested by the disappearance of the closing cortical plates at the tops of the alveolar process. X-ray examination is especially important for diagnosing the initial degree of development of periodontal pathology.

To calculate the index, the obtained scores are added up and divided by the number of teeth present according to the formula:

PI = Sum of scores for each tooth / Number of teeth

The index values ​​are as follows:

0.1–1.0 - initial and mild degree of periodontal pathology;

1.5–4.0 - moderate degree of periodontal pathology;

4.0–4.8 - severe degree of periodontal pathology.

Index of need in the treatment of periodontal diseases

To determine the index of need in the treatment of periodontal disease (CPITN), it is necessary to examine the surrounding tissues in the region of 10 teeth (17, 16, 11, 26, 27 and 37, 36, 31, 46, 47).

This group of teeth creates the most complete picture of the state of periodontal tissues of both jaws.

The study is carried out by probing. With the help of a special (button) probe, bleeding gums, the presence of supra- and subgingival "tartar", a clinical pocket are detected.

The CPITN index is evaluated by the following codes:

- no signs of disease;

- gingival bleeding after probing;

- the presence of supra- and subgingival "tartar";

– clinical pocket 4–5 mm deep;

– clinical pocket with a depth of 6 mm or more.

In the corresponding cells, the condition of only 6 teeth is recorded. When examining periodontal teeth 17 and 16, 26 and 27, 36 and 37, 46 and 47, codes corresponding to a more severe condition are taken into account. For example, if bleeding is found in the area of ​​tooth 17, and “tartar” is found in area 16, then the code denoting “tartar” is entered in the cell, i.e. 2.

If any of these teeth is missing, then examine the tooth standing next to the dentition. In the absence of a nearby tooth, the cell is crossed out diagonally and not included in the summary results.
From the official website of the Department of Therapeutic Dentistry, St. Petersburg State Medical University

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 assessed 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 state 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 following 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 of the 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.

Schiller-Pisarev test.

In a clinical assessment of the state of periodontal tissues, first of all, attention is paid to the state of the mucous membrane of the gums:

1. the presence of inflammation;

2. intensity of inflammation;

3. prevalence of inflammation.

The Schiller-Pisarev test is based on the fact that in the presence of inflammation, the gums are stained with an iodine-containing solution from brown to dark brown (lifetime glycogen stain).

Most often, iodine-potassium solution is used for staining (1 g of crystalline iodine and 2 g of potassium iodide are dissolved in 1 ml of 96% ethanol and distilled water is added to 40 ml) or Lugol's solution. The intensity of staining of the gums depends on the severity of the inflammatory process, which is accompanied by the accumulation of glycogen in the cells of the mucous membrane of the gums.

In children under 3 years of age, the Schiller-Pisarev test is not performed, since the presence of glycogen in the gums is a physiological norm.

Intense coloration of the gums indicates the presence of gingival inflammation. The degree of spread of gingivitis is determined using the PMA index.

Topic: Signs of inflammation of the gums. Purpose: To teach how to assess the clinical condition of the gums using the Schiller-Pisarev test to calculate the RMA PI CPITN KPI USP indices. Visual examination allows you to roughly determine the condition of the gums. The color of the gums is pale pink.

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Page 5

METHODOLOGICAL DEVELOPMENT

practical exercises No. 6 - 7

by section

IV semester).

Subject: Signs of inflammation of the gums. Schiller-Pisarev test, its meaning. RMA index, its definition, calculation. Clinical significance of the PI index, CPITN, KPI, USP.

Target: To teach how to assess the clinical condition of the gums using the Schiller-Pisarev test, calculate the RMA, PI indices, CPITN, KPI, USP.

Place of employment: Hygiene and prevention room GKSP No. 1.

Material support:Typical equipment of a hygiene room, a dentist's workplace - prevention, tables, stands, an exhibition of hygiene and prevention products, a laptop, a solutionSchiller-Pisarev.

Lesson duration: 3 hours (117 min).

Lesson Plan

The lesson begins with a briefing by the teacher about the content and objectives of the lesson. During the survey, find out the initial level of knowledge of students. In the process of classes with students, the signs of inflammation are analyzed, and what causes them. Further, special methods for assessing inflammation are discussed. The teacher shows the methodology for conducting the Schiller-Pisarev test, calculating the RMA, PI, CPITN , KPI, USP. Further, an independent examination of the oral mucosa, an assessment of the level of gum health, a Schiller-Pisarev test, and calculation of indices. The lesson ends with the solution of situational problems and test tasks.

According to the WHO definition (1980), the periodontium is a combination of several tissues that support the tooth, connected in their development topographically and functionally.

The periodontium includes gum, cement, periodontal ligament (desmodont or periodontium), alveolar bone.

Clinical examination of the patient allows you to determine the condition of the periodontium, first of all, its visible part - the mucous membrane of the alveolar part or the alveolar process. Visual examination allows you to roughly determine the condition of the gums. Gingival papillae in the area of ​​single-rooted teeth are triangular in shape, in the area of ​​molars - triangular and trapezoid. The color of the gums is pale pink. Atrophy of the gingival margin, hypertrophy of the gingival papillae, cyanosis, hyperemia, indicate a pathological condition of the periodontium.

At the same time, methods are required to quantify the condition of the periodontium and to objectify the results of a clinical examination. Such a need arises to quantify the degree of periodontal inflammation, assess the dynamics of the course of periodontal diseases and the effectiveness of treatment.

Many methods are based on the Schiller-Pisarev test. Its principle is to stain the gums with Schiller-Pisarev's solution of glycogen (reaction with iodine). With inflammation, glycogen accumulates in the gums due to keratinization of the epithelium. Therefore, when interacting with iodine, the inflamed gum stains more intensely than healthy gums. It acquires shades from light brown to dark brown. A more intense color indicates a greater degree of inflammation. The Schiller-Pisarev test is carried out as follows: the examined gum area is drained with a cotton swab, isolated from saliva and lubricated with a cotton ball dipped in Lugol's solution or Schiller-Pisarev's solution. The Schiller-Pisarev test is used in children to detect gingivitis. To do this, stain the gums with the following solution:

Potassium iodide - 2.0

Crystalline iodine -1.0

Distilled water - up to 40.0

Healthy gums are not stained with this solution. A change in its color under the action of this solution occurs during inflammation, and then the sample is considered positive.

Assessment of periodontal condition

Control questions to identify the initial knowledge of students:

Scheme of the orienting basis of action -

determining the clinical condition of the gums.

Situational tasks

1. A 10-year-old child, after the Schiller-Pisarev test, brown coloration of the gingival papillae appeared in 4 teeth, the marginal gingiva in 8 teeth, and the alveolar gingiva in 2 teeth. Calculate the PMA index.
2. Patient K. The PMA index is 75%. Assess the condition of the gums. Is it possible to say about the depth of damage to periodontal tissues?
3. The PI index is 3.8 points. What is the degree of periodontal damage?

List of literature for preparation for classes in the section

"Prevention and epidemiology of dental diseases"

Department of Pediatric Dentistry, OmGMA ( IV semester).

Educational and methodical literature (basic and additional with the heading of UMO), including those prepared at the department, electronic teaching aids, network resources:

Preventive section.

A. BASIC.

1. Pediatric therapeutic dentistry. National leadership: [with adj. on CD] / ed.: V.K.Leontiev, L.P.Kiselnikova. - M.: GEOTAR-Media, 2010. - 890s. : ill.- (National project "Health").
2. Kankanyan A.P. Periodontal disease (new approaches to etiology, pathogenesis, diagnosis, prevention and treatment) / A.P. Kankanyan, V.K.Leontiev. - Yerevan, 1998. - 360s.
3. Kuryakina N.V. Preventive dentistry (guidelines for the primary prevention of dental diseases) / N.V. Kuryakina, N.A. Saveliev. - M .: Medical book, N. Novgorod: Publishing house of NGMA, 2003. - 288s.
4. Kuryakina N.V. Therapeutic dentistry of childhood / ed. N.V. Kuryakina. – M.: N.Novgorod, NGMA, 2001. – 744p.
5. Lukinykh L.M. Treatment and prevention of dental caries / L.M. Lukinykh. - N. Novgorod, NGMA, 1998. - 168s.
6. Primary dental prophylaxis in children. / V.G. Suntsov, V.K.Leontiev, V.A. Distel, V.D. Wagner. - Omsk, 1997. - 315p.
7. Prevention of dental diseases. Proc. Manual / E.M. Kuzmina, S.A. Vasina, E.S. Petrina et al. - M., 1997. - 136p.
8. Persin L.S. Dentistry of children's age /L.S. Persin, V.M. Emomarova, S.V. Dyakova. – Ed. 5th revised and supplemented. - M .: Medicine, 2003. - 640s.
9. Handbook of Pediatric Dentistry: Per. from English. / ed. A. Cameron, R. Widmer. - 2nd ed., Rev. And extra. - M.: MEDpress-inform, 2010. - 391 p.: ill.
10. Dentistry of children and adolescents: Per. from English. / ed. Ralph E. McDonald, David R. Avery. - M.: Medical Information Agency, 2003. - 766 p.: ill.
11. Suntsov V.G. The main scientific works of the Department of Pediatric Dentistry / V.G. Suntsov, V.A. Distel and others - Omsk, 2000. - 341p.
12. Suntsov V.G. The use of therapeutic and prophylactic gels in dental practice / ed. V.G. Suntsova. - Omsk, 2004. - 164p.
13. Suntsov V.G. Dental prophylaxis in children (a guide for students and doctors) / V.G. Suntsov, V.K. Leontiev, V.A. Distel. – M.: N.Novgorod, NGMA, 2001. – 344p.
14. Khamadeeva A.M., Arkhipov V.D. Prevention of major dental diseases / A.M. Khamdeeva, V.D. Arkhipov. - Samara, Samara State Medical University - 2001. - 230p.

B. ADDITIONAL.

1. Vasiliev V.G. Prevention of dental diseases (Part 1). Educational-methodical manual / V.G.Vasiliev, L.R.Kolesnikova. - Irkutsk, 2001. - 70s.
2. Vasiliev V.G. Prevention of dental diseases (Part 2). Educational-methodical manual / V.G.Vasiliev, L.R.Kolesnikova. - Irkutsk, 2001. - 87p.
3. Comprehensive program of dental health of the population. Sonodent, M., 2001. - 35s.
4. Methodical materials for doctors, educators of preschool institutions, school accountants, students, parents / ed. V.G. Vasilyeva, T.P. Pinelis. - Irkutsk, 1998. - 52p.
5. Ulitovsky S.B. Oral hygiene is the primary prevention of dental diseases. // New in dentistry. Specialist. release. - 1999. - No. 7 (77). - 144s.
6. Ulitovsky S.B. Individual hygienic program for the prevention of dental diseases / S.B. Ulitovsky. - M .: Medical book, N. Novgorod: NGMA Publishing House, 2003. - 292 p.
7. Fedorov Yu.A. Oral hygiene for everyone / Yu.A. Fedorov. - St. Petersburg, 2003. - 112p.

The staff of the Department of Pediatric Dentistry published educational and methodological literature with the UMO stamp

Since 2005

1. Suntsov V.G. Guide to practical classes in pediatric dentistry for students of the pediatric faculty / V.G. Suntsov, V.A. Distel, V.D. Landinova, A.V. Karnitsky, A.I. .Khudoroshkov. - Omsk, 2005. -211s.
2. Suntsov V.G. Suntsov V.G., Distel V.A., Landinova V.D., Karnitsky A.V., Mateshuk A.I., Khudoroshkov Yu.G. Guide to pediatric dentistry for students of pediatric faculty - Rostov-on-Don, Phoenix, 2007. - 301s.
3. The use of therapeutic and prophylactic gels in dental practice. Guide for students and doctors / Edited by Professor V. G. Suntsov. - Omsk, 2007. - 164 p.
4. Dental prophylaxis in children. A guide for students and doctors / V.G. Suntsov, V.K. Leontiev, V.A. Distel, V.D. Wagner, T.V. Suntsova. - Omsk, 2007. - 343s.
5. Distel V.A. The main directions and methods of prevention of dentoalveolar anomalies and deformities. Manual for doctors and students / V.A. Distel, V.G. Suntsov, A.V. Karnitsky. - Omsk, 2007. - 68s.

e-tutorials

Program for the current control of students' knowledge (preventive section).

Methodological developments for practical training of 2nd year students.

"On Improving the Efficiency of Dental Care for Children (Draft Order of February 11, 2005)".

Requirements for sanitary-hygienic, anti-epidemic regimes and working conditions for those working in non-state healthcare facilities and offices of private dentists.

Structure of the Dental Association of the Federal District.

Educational standard for postgraduate professional training of specialists.

Illustrated material for state interdisciplinary exams (04.04.00 "Dentistry").

Since 2005, the staff of the department has published electronic teaching aids:

Tutorial Department of Pediatric Dentistry, OmGMAon the section "Prevention and epidemiology of dental diseases"(IV semester) for students of the Faculty of Dentistry / V. G. Suntsov, A. Zh. Garifullina, I. M. Voloshina, E. V. Ekimov. - Omsk, 2011. - 300 Mb.

Video films

1. Educational cartoon on brushing teeth by Colgate (children's dentistry, prevention section).
2. "Tell the doctor", 4th scientific and practical conference:

G.G. Ivanova. Oral hygiene, hygiene products.

V.G. Suntsov, V.D. Wagner, V.G. Bokai. Problems of prevention and treatment of teeth.

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RMA index. - Schiller-Pisarev test. - Gingival index GI. - Communal periodontal index CPI. — Complex periodontal index KPI. - Gingival recession index. - Loss of gingival attachment index. – Diagnosis of risk factors for the development of periodontal pathology and drawing up a plan of preventive measures.

Assessing the condition of the periodontium using visual and tactile methods, pay attention to the condition of the gums (color, size, shape, density, bleeding), the presence and location of the dentogingival junction relative to the enamel-cement border (i.e., the presence and depth of pockets), for tooth stability.

For more subtle studies of the condition of the periodontium, radiography is used (parallel technique, orthopantomogram, tomogram), less often electronic devices are used to determine the degree of tooth mobility, and diagnostic bacteriological tests are performed (see below). In periodontal practice, a special card is filled out, in which the degree of pathological changes in the area of ​​each tooth is recorded during the initial examination of the patient, and the dynamics of the condition during treatment are noted.

To standardize and simplify the registration records produced for clinical and epidemiological purposes, in our country and in the world, it is common to use gingival and periodontal indices, which more or less fully describe the state of the entire periodontium or its “symbolic” areas.

RMA index (Schur, Massler, 1948)

Schiller-Pisarev test

The sample can be evaluated as negative (straw yellow), weakly positive (light brown) or positive (dark brown).

This test cannot be used to diagnose periodontal pathology in children under 6 years of age, since their healthy gums contain a large amount of glycogen.

Gingival GI index (Loe, Silness, 1963)

The condition of four sections of the gum near each tooth is studied: the medial and distal papilla from the vestibular side, the edge of the gum from the vestibular and lingual sides. The condition of each gum area is assessed as follows:
0 - gum without signs of inflammation;
1 - slight discoloration, slight swelling, no bleeding on examination (mild inflammation);
2 - redness, swelling, bleeding on examination (moderate inflammation);
3 - severe hyperemia, edema, ulceration, tendency to spontaneous bleeding (severe inflammation).

Interpretation:
0.1-1.0 - mild gingivitis;
1.1-2.0 - moderate gingivitis;
2.1-3.0 - severe gingivitis.

Communal Periodontal Index CPI (1995)

The probe scale is arranged as follows: the diameter of the “button” is 0.5 mm, a black mark is located at a distance of 3.5 mm to 5.5 mm, two rings are located at a distance of 8.5 and 11.5 mm (Fig. 6.12) .

Fig.6.12. Periodontal bellied probe.

1. The working part of the probe is placed parallel to the long axis of the tooth in one of four loci: in the distal and medial parts of the vestibular and oral surfaces.

2. A probe button with a minimum pressure (up to 20 g) is inserted into the space between the tooth and soft tissues until an obstacle is felt, i.e. to the dental junction. Pressure restrictions are necessary to prevent destruction of the dentoepithelial junction. Since objective measurements of pressure in this situation are impossible, it remains to train the proprioceptive control of the researcher's muscular efforts. To do this, the researcher must put a button probe on his nail and record in muscle memory a force sufficient to ischemia the nail bed, but painless.

3. The depth of probe immersion is noted: if the edge of the gum covers only the “button” and a small part of the light interval of the scale between the “button” and the black mark, the gingival groove has a normal depth, if some part of the black mark is immersed under the gum, the pathological pocket has a depth 4-5 mm. If the entire dark part of the probe is immersed, the pocket has a depth of more than 6 mm.

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

5. The movements are repeated, moving the probe to the medial surface of the tooth.

6. The study is carried out on the oral surface of the tooth.

7. At the end of probing, wait 30-40 seconds and observe the gum to determine bleeding.

Registration of index data is carried out according to the following codes:
0 - healthy gum, no signs of pathology;
1 - bleeding 30-40 s after probing with a pocket depth of less than 3 mm;
2 - subgingival tartar;
3 - pathological pocket 4-5 mm deep;
4 - pathological pocket with a depth of 6 mm or more.

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

To assess the condition of the periodontium as a whole, it is necessary to conduct a study in each of the three sextants (the border between the distal and frontal sextant passes between the canine and premolar) on both jaws. In adults (over 20 years old), the periodontal condition of 10 teeth is studied: 11, 16 and 17, 11, 26 and 27, 31, 36 and 37, 46 and 47, but in each sextant the periodontal condition of only one tooth is recorded, fixing the tooth with the most severe clinical condition of the periodontium. To avoid overdiagnosis, the periodontium of recently erupted second molars is excluded from the study: CPI of teeth 11, 16, 26, 36, 31, 46 are studied from the age of 15 to 20 years. For the same reason, when examining children (persons under 15 years old), the depth of the gingival grooves do not investigate, take into account only bleeding gums and the presence of a stone.

The analysis takes into account the number of sextants with codes 0, 1.2, 3, 4 (without calculating averages). In epidemiological studies, the proportion of people who have one or another number of sextants with one or another code is calculated.

T.V. Popruzhenko, T.N. Terekhova