Statistical indicators of the prevalence of caries and its intensity: compensated and acute forms. Indicators of dental morbidity (prevalence, intensity, increase in intensity)

Dental caries (caries dentis; from the Latin caries - decay) is a pathological process that is manifested by demineralization and progressive destruction of hard tooth tissues with the formation of a defect in the form of a cavity.

Caries has been known since ancient times. Information about this disease appeared in written sources around 3000 BC. e. At that time, caries was not yet so widespread, but in the Middle Ages it began to affect more and more people. This is associated with changes in nutrition, environmental and living conditions. So, starting from the 18th century, the frequency of caries begins to increase sharply, and in our time its prevalence in some regions of the globe reaches 100%. There are different levels of caries incidence - from 1-3% in Western European countries to 80-97% in Africa, Asia, and the CIS. This is explained by a number of factors: the nature of the diet (primarily an excess of carbohydrates and a relative lack of proteins in the diet), fluorine content (0.8 mg/l in hot countries, 1 mg/l in temperate climates, 1.5 mg/l in northern latitudes) and other macro- and microelements in drinking water, social and climatic-geographical conditions.

In epidemiological studies, a number of indicators are used to assess the condition of teeth when they are affected by caries: the prevalence of caries, the intensity of the process, morbidity (increase in intensity over a certain period of time).

Prevalence of caries.

It is calculated by dividing the number of people who have carious, filled and extracted teeth (regardless of the number of carious teeth in each of them) by the total number of those examined and is expressed as a percentage:

The intensity of caries damage in one examined person is determined by the index of dental CP of teeth and CP of cavities. The CPU index of teeth is the sum of carious (C), filled (P) and removals due to complications of caries (U) teeth in one examinee. When determining this and other average values ​​of intensity indices for a significant number of the population, their sum is divided by the number of those examined. When determining the CPU index, a tooth containing one or more cavities is considered to be affected by caries, filled with one or more fillings, regardless of their size and condition. If a tooth has both a filling and a carious cavity, then it is considered carious. In children, the index is calculated depending on the occlusion: in the permanent dentition, the permanent teeth affected by caries are taken into account (KPU index), in the temporary (milk) - index kp (carious and filled) and in the mixed dentition - permanent and temporary teeth (KPU + kp) .

KPU index.

It is a fairly informative indicator that allows one to judge the level of caries intensity. According to WHO recommendations, there are five levels of caries intensity: very low, low, medium, high and very high.

Sometimes, for a more complete and accurate assessment of the condition of the teeth, the CPP (cavity) index is calculated, which takes into account the number of carious cavities and fillings. Unlike the tooth index, the total number of carious cavities and fillings is calculated, regardless of the number of affected teeth. That is, if one tooth has three separate carious cavities, then in the CP index of teeth it is counted as one, and in the CP index (cavities) - as three units. This index is especially indicative at low intensity of caries damage.

Morbidity (increase in caries and its intensity) - the average number of new teeth affected by caries, which are determined over a certain period of time, based on one examined person. Typically, the increase in caries is determined after one year, and with the active course of the pathological process - after 6 months.

Epidemiological indicators.

The incidence of caries during mass dental examinations of the population should be taken into account in different age groups. This is due to the different susceptibility to caries in children and the presence of temporary teeth. Accordingly, they should be taken into account in adults as well. According to WHO recommendations, adults are divided into the following age groups: young, middle-aged and elderly.

The prevalence and intensity of caries in the population depends on a number of factors. Very important are geographical factors, which include climate, solar activity, the content of various minerals (calcium, phosphorus) and some trace elements (fluorine) in the soil and drinking water.

According to modern ideas, one of the main reasons

The occurrence of caries is due to irrational, unhealthy diet. Typically, the diet is dominated by overly processed, refined foods high in carbohydrates. When cooking food, a large amount of substances necessary for the body is lost. An imbalance of nutrition leads to insufficient intake of essential components into the body: vitamins, amino acids (lysine, arginine), etc. The importance of a balanced diet is confirmed by data from epidemiological, clinical and experimental studies.

The prevalence of caries also depends on a person’s age, which is due to the different number of teeth in children and adults and the susceptibility of tissues to caries (temporary teeth are more easily affected than permanent teeth). This is taken into account during the study. In children, a rather low CP + CP index can be regarded as an indicator of a very intense carious process due to premature removal of baby teeth. There were no significant gender differences in the prevalence and intensity of caries. Only during certain periods of life, for example, during pregnancy, do women have an increased tendency to caries, which can result in an increase in the number of teeth affected by caries.

General condition of the body.

In particular, past and concomitant diseases have a certain impact on the incidence of dental caries. Its high frequency has been noted in children who have suffered infectious diseases or have diseases of internal organs. Changes in the general and immunological reactivity of the body have a significant impact on the occurrence of caries.

The hygienic condition of the oral cavity and the level of dental care are one of the important factors in the occurrence of caries. Regular dental care using modern preventive and hygiene products is a very effective method of preventing dental caries. To a certain extent, uneven cleaning of teeth leads to an increase in the incidence of caries in them. Often, caries affects teeth whose crowns have a rather complex anatomical shape (a large number of fissures, pits), etc. According to the frequency of damage to individual teeth by caries (I. O. Novik, 1958), they can be placed in this way: first molars, second and third molars, premolars, upper incisors, lower incisors, canines. Analysis of the CP index (cavities) allows us to identify the surfaces of the teeth that are most often affected by the carious process. In permanent teeth, caries is usually localized on contact, chewing surfaces and in the cervical area. Caries is also characterized by symmetrical damage to the teeth, which is explained by the identity of the conditions and their anatomical structure.

The sensitivity of teeth to caries is also affected by a violation of the structure of their hard tissues, which is often a consequence of general diseases, systemic disorders of the body, etc.

The opinion that bad teeth are a disease only of modern people is incorrect.

Caries has become widespread back in Neolithic times. Since then, medicine has continued to fight the disease.

Prevalence And intensity act as the main indicators of carious lesions.

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

The importance of researching the problem

The study of the etiology and pathology of caries is still one of the main priorities modern dentists, because statistics allow us to draw conclusions about 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;
• carrying out population differentiation by the nature of the risk of disease;
• development preventive measures;
• assessments existing preventive methods, their effectiveness;
• assessing the relevance of carious pathologies for certain groups of people.

When making calculations, experts rely on odds, obtained within the scales:

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

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

Prevalence and intensity of caries

According to statistics, no residents were protected 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 decrease 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 those examined. According to statistics, after 35 years, almost every person in the country has dental problems.

In pre-war Europe, according to statistics, people suffered from caries 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 of mostly older people. The older the study group, the higher the prevalence and intensity.

Caries is common in Russia 100%: Every adult Russian needs dental help 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 space, the so-called blind fossae.

Important! The upper jaw suffers to a greater extent, than the bottom, and from above they take the main blow front teeth, and below - chewable and root.

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

Index as an indicator of the degree of disease development

When assessing the intensity of lesions, a special caries index. This is an indicator of the degree of development of the disease for each specific person. Approach to adults and children varies:

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

The prevalence and intensity index among the studied population is determined according to certain rules. First they calculate individual index for each representative of the group, and then calculate arithmetic mean.

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

The prevalence rate is low - up to thirty percent, the average reaches and eighty, and high and one hundred percent.

When determining intensity, experts rely on the following indices:

1. Intensity of lesions baby teeth. Two indicators are used here: KP(z) and KP(p) - the sum cured And those in need in fillings of teeth and surfaces, respectively. The principle of calculation here is the same: the indicators for each representative of the group are determined, all the numbers are added together and then divided by the number of subjects.
2. Intensity of lesions permanent teeth. These are KPU(z) indices - here we are talking about the amount those in need of treatment, cured And torn out human teeth and CPU (n). The latter implies the sum of all surfaces that need treatment or on which fillings are placed. An extracted tooth counts as five surfaces.

Reference. When calculating, they neglect early forms of the disease(spot stage, superficial caries). Therefore, experts are critical of the existing statistics system, because it represents a more optimistic picture than what actually is.

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

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Growth rate

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

The lower limit is standard year: During this time, new lesions develop in an ordinary citizen who is considered healthy.

In relation to people suffering from various pathologies of internal organs, as well as especially rapidly developing carious lesions, it is established six months period.

Definition of reduction

Reduction in growth indicates percentage difference for two homogeneous quantities. Usually, the increase in the intensity of lesions on the dental surface is compared between representatives of the preventive and control groups.

Epidemiology indicators

Modern scientists have no doubt that caries takes first place by popularity among diseases. Even in economically developed countries in 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. A dentist conducts a preventive examination of a small patient in order to identify and treat caries in the early stages.

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

The intensity and prevalence of caries are considered the main sources of statistics for this disease. Data are regularly collected on the frequency and speed of the disease in all age groups of patients, depending on the influence of external and internal factors on their dental system. Thanks to the quantitative recording of disease outbreaks, scientists can conduct scientific research, and dentists can carry out preventive and therapeutic work in the fight against caries.

For dentistry, caries is considered a pressing problem that has to be dealt with every day. However, working with the disease separately, it is impossible to achieve positive results in the form of reducing massive outbreaks of lesions. This is why disease statistics are kept all over the world.

The collected data helps not only to increase the professional level of dentists, but also to introduce the latest diagnostic and treatment methods into practice. As a result, dental caries statistics help improve the quality of dental services.

To establish a diagnosis, the dentist interviews the patient and records all the information in the medical record - the main document for recording the doctor’s work. When treatment ends, the card remains with the dentist for five years, then is archived for 75 years. Thanks to a well-coordinated storage system, it is possible to track and collect statistical data on the development of caries at any time.

Main tasks of statistics

Dental research relies on statistical data on caries, its prevalence, intensity and duration in different patients. When collecting information, the following tasks are set:

• studying the mechanism of origin and development of the disease in its individual manifestations;
• studying the origin of the disease in general: the conditions and causes of its occurrence;
• division of the population according to the degree of risk of developing the disease;
• drawing up future forecasts of the development of the disease for planning preventive care and adequate provision of dental services to the population;
• assessment of the effectiveness of created preventive and therapeutic methods;
• determining the degree of development of the disease in the examined group of patients in order to correct errors that have appeared and plan new directions in methods of prevention and treatment.

Important indicators when collecting information

When conducting mass examinations, dentists take into account, first of all, the age of the patients. Children have different susceptibility to caries, and they also have two types of teeth: temporary and permanent. It is known that baby teeth are more susceptible to caries. Accordingly, children belong to a separate, pediatric group of patients. In addition to this age group, there is a group of adults, consisting of three subgroups: young (adolescent) age, middle and old.

The next point when collecting information on the spread of caries is external and internal influencing factors. This includes the patient’s place of residence: whether the climate is suitable for his health, whether there is enough sunlight, whether the drinking water contains the required amount of minerals, micro and macroelements.

The patient's diet also plays an important role in the occurrence of dental damage. An unbalanced diet is the cause of a deficiency of vitamins and minerals in the body. As a result, a person’s immunity weakens, often causing illness. Other causes of the disease can be found in the article.

Prevalence of the disease

According to the list of terms used by WHO - the World Health Organization, four main parameters are used to assess dental damage: the intensity of dental caries, its prevalence, increase and decrease in intensity over a specific period of time.

Disease prevalence is a calculation of a certain ratio, expressed as a percentage. When calculating, take the number of patients in whom at least one sign of tooth damage was noticed during examination, and the number of all examined patients. Formula for calculating the required number: ((patients with caries)/(total number of patients examined))×100%.

The incidence of caries depends on the result obtained: up to 30% - low, from 31% to 80% - average, more than 80% - high.

In some cases, a term is used that is more suitable in meaning for the purposes of statistics of the manifestation of the disease - patients without caries. As a result, the inverse prevalence indicator is calculated according to the formula: ((patients without caries)/(total number of examined patients))×100%.

A low level of disease prevalence means that patients without caries make up more than 20% of the total percentage of those examined, medium – from 5% to 20%, high – up to 5%.

Conservative, sedentary parameter

In each region, research results are used to a limited extent, only to increase the level of preventive measures against caries. All obtained indicators of the prevalence of the disease are compared with each other in different regions, aiming at mass eradication of the problem.

This state of affairs is associated with the specifics of the disease - if a person begins to have dental damage, then he will forever remain in the group of patients. Even if it was a long time ago, and caries was stopped or cured. Accordingly, the prevalence of the disease is a sedentary, routine parameter. That is why assessing the effectiveness of preventive measures is only possible by comparing large groups of patients of different ages and from different places of residence.

Disease intensity

To solve statistical problems, it is necessary to take into account not only the fact of the development of the disease. To improve the level of dental services, an assessment of the intensity of caries is needed.

To calculate the degree of intensity of the disease, scientists from WHO came up with a special index of the sum of damaged teeth - SPU, where K - teeth affected by caries, P - filled teeth, U - teeth removed. The intensity of dental caries is calculated according to the formula: ((K+P+U)/(total number of surveyed)).

Children with temporary (baby) teeth are given the index kp, where k is teeth affected by caries, p is filled teeth. For children whose temporary teeth are being replaced by permanent ones, the intensity of the disease is calculated using the index KPU+KP.

In mass studies of the intensity of the disease in children, it begins to be calculated from about 12 years of age, when the replacement of temporary teeth with permanent ones has ended. Such restrictions are considered the most informative, since the level of caries damage to primary teeth is a relative concept and not a constant one. WHO identifies five degrees of disease intensity, which can be found in the table:

Intensity waxing and waning

The increase in caries activity is studied for each patient individually. Dentists examine how many healthy teeth have been affected by the disease over a certain period of time. Typically, the doctor examines the patient every two to three years, in case of sudden deterioration - every three to six months.

The increase in morbidity is the difference in the indicators of the PCI index between the last examination of the patient and the previous one. Thanks to these studies, the dentist can plan a treatment method and a method of prevention based on the needs of each patient.

Based on this, scientist T.F. Vinogradova identified three types of disease development activity, which can be found in the article.

If prevention and treatment help, the activity of caries lesions begins to weaken - the disease is reduced. This information is measured using the formula: ((Mk-M)/Mk))×100%.

Mk is the increase in the disease in patients before preventive and therapeutic work, M is the increase in the disease after undergoing dental procedures.

Degree of provision of dental services to the population

In certain areas serving the population, the following indicators of the provision of dental services are studied:

• the number of people who sought help;
• availability of services;
• providing dentists with jobs;
• the ratio of the number of dentists to the number of people living in a particular area;
• providing the population with dental chairs.

During large-scale studies of the provision of dental services to the population, several groups of patients are simultaneously examined in certain regions, each of which must contain at least 20 people. Formula for identifying the level of dental care (USL): 100%-((k+A)/(KPU))×100, where k is the average number of teeth affected by caries, without treatment, A is the average number of teeth removed without restoration of their functions with the help of dentures. If the indicator is more than 75%, then the USP is good, 50%-74% is satisfactory, 10%-49% is insufficient, and less than 9% is bad.

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In the dental service, much attention is paid to caries intensity indicators. Based on them, you can consider how actively and effectively measures are being taken to maintain oral health.

According to the WHO classification, several statistical values ​​of carious lesions are assessed:

• prevalence percentage;
• intensity of dental caries (expressed in KPU);
• its growth;
• decrease in growth.

Statistical indicators are directly related to age. The older the persons being sanitized, the higher the prevalence and intensity of the course of carious disease will be.

Oksana Shiyka

Dentist-therapist

Pay attention! In addition to carious indicators, there are periodontal indicators (CPI), identification of enamel damage not due to caries (according to Kuzmina), calculation of the level of dental care - allows you to find out the need for sanitation.

Why do we need statistics on the prevalence and intensity of caries?

Based on statistical data, we can draw a conclusion about the prevalence of caries. The indicator is based on the number of patients examined with. For example, of 100 people examined, 90 have carious lesions or fillings. This means that the prevalence of caries will be 90%. A completely healthy oral cavity for those who have never had caries. These statistics show the need of the population for dental care and how effectively prevention is carried out.

The intensity of caries is the ratio of carious, filled and extracted teeth of a particular patient. The indicator allows you to judge the quality of care provided and get an idea of ​​the upcoming volume of medical dental or orthopedic care.

Based on statistical data, the Ministry of Health receives information not only about the quality of services and the health of the population, but also about how much medical staff will be needed and how much finance to allocate for the needs of the dental sector in the next reporting period.

Forms of the disease in children and adults

Regardless of age, caries develops as follows and has the following:

• begins at the stain stage - roughness appears on the enamel;
• develops to the surface - affects tooth enamel, but does not yet reach dentin;
• passes into the middle - forms a cavity in dentin;
• formation of a deep lesion.

There are several types of caries:

• multiple – affects several teeth at once;
• fissure – based in natural depressions;
• interdental - it is provoked by food particles stuck in a difficult-to-clean space;
• circular - thins the enamel around the tooth, closer to the gum, can appear on several teeth at once;
• cervical - bacteria destroy the enamel near the gums;
• root - often associated with gum problems;
• secondary - develops under or next to the filled area.

In children, the process develops more rapidly than in adults, because the immune system has not yet fully matured, and it is more difficult for it to fight bacteria. In addition, children's enamel is thinner, so it is more susceptible to damage.

Estimation of caries prevalence

When calculating the indicator, three numbers are taken into account:

• number of people examined;
• previously sanitized (i.e. those who have fillings in their mouth - cured caries);
• healthy.

After which it is calculated according to the formula: patients with caries are divided by the number of examined persons and multiplied by 100%. If a patient has at least one tooth in his mouth that has been treated for caries, it is considered previously sanitized and not healthy. Example: 200 people were examined, 100 of them had fillings, and 40 had no problems with this disease at all. We count: 160/200*100%=80%.

The resulting prevalence result is correlated with WHO standards:

• increased – 81%-90%;
• average – 31%-80%;
• reduced – 0%-30%.

Oksana Shiyka

Dentist-therapist

Important! The prevalence of caries is calculated as a percentage of the number of patients suffering from this disease to the people examined.

The prevalence shows the extent of the disease, but it does not show the severity of the disease in a particular patient or in a group of people with caries. This is shown by the following statistical element.

Disease intensity

The penetration of caries into permanent teeth is indicated by the index KPU (carious teeth, filled, extracted). For milk teeth, kp is written - in lowercase letters, but means the same thing - carious and filled teeth. Extracted temporary teeth are not marked because their replacement is part of the natural process of life and they are extremely rarely lost due to caries. You can find the designation KPUp - the last letter is used to designate cavities or surfaces, since there are several of them on a tooth:

• on the crown;
• cervical, root section;
• on the root.

An additional carious cavity does not always form in a different place on the tooth; it can appear on the other side of the filling. For example, an area on the vestibular (outer) side is filled, and caries has developed on the lingual (back) wall. To indicate caries during the period of change of occlusion, if it is present on milk and permanent teeth, the index KPU + kp is used. If a carious tooth has a filling, it is considered carious. The fate of demineralized enamel (the very beginning of the carious process) is not included in the KPU index. Calculated for 28 teeth - third molars (wisdom teeth) are not included.

The results obtained are added up and the KPU index is calculated, which is also considered the intensity of dental caries. For example, K=1, P=2, U=1. In total 4. The result obtained is checked against the WHO table, and it is important to take into account the age of the patient being examined.

Age	Intensity
	Very low	Low	Average	High	Very high
12	0 – 0,1	1,2 – 2,6	2,7 – 4,4	4,5 – 6,5	6,6 +
34 – 40	0 – 0,5	1,6 – 6,2	6,3 – 12,7	12,8 – 16,2	16,3 +

Oksana Shiyka

Dentist-therapist

Important! If Y (deletion) predominates in the KPU, this is an alarming indicator.

Modern dentistry is aimed at maximizing the preservation of one’s teeth, so a large number of extracted teeth makes one think about the quality of the care provided.

Intensity increase

This indicator is calculated for each individual person, coupled with the dynamics of previous carious lesions. The period varies – 6 months, a year or more. For the study, the past CPU and the current one are compared. For example, in 2017 the patient had a KPU = 2, and in 2018 his KPU = 3. The increase was 1 carious, filled or extracted tooth.

Oksana Shiyka

Dentist-therapist

Important! With effectively carried out preventive measures, the increase in caries is not observed or slows down.

The increase in intensity is calculated only if additional carious cavities have formed during the period taken for the study. This indicator is especially relevant for patients with an active course of the disease or for those who have problems with internal organs. They can be examined every six months to prevent a strong increase in the intensity of caries.

Methodology for determining reduction

The reduction (decrease) of the disease is determined over time. To do this, take a control and an experimental group and calculate the average increase in the indicator. If it decreases, a percentage is displayed. For example, the control group was taken in 2016, the increase a year later was 2.0, and the experimental group had an annual increase of 1.0. The reduction in this case is 50%.

The following measures influence the increase in the reduction level:

• carrying out preventive measures;
• improving the quality of medical care provided;
• training in proper cleaning;
• improvement of lifestyle;
• increasing self-awareness of the population and regular visits to the dentist.

It turns out that for comparison we take not the intensity of the carious process, but its increase over a certain period. KPU, like the number of filled or extracted teeth, cannot decrease, but the increase in intensity may decrease. If the disease does not affect other teeth, their number does not increase, we can talk about a reduction (decline) in the growth of caries.

Epidemiological indicators

Caries epidemiology is a branch that studies how common and intense dental caries is. Helps to understand the level of dental health of the population, but not only. Main tasks:

• identifying the percentage of caries prevalence and the intensity of its course;
• establishing the quality of care provided;
• identifying the population's need for dental care;
• comparison of the number of sick people in different areas;
• planning medical rates (+ how much dental personnel will be needed to train), equipment and financial support for providing dental care;
• the ability to track the effectiveness of preventive care over time using several examinations;
• determining the scope of work for those companies that produce pastes, rinses and other items for maintaining dental hygiene.

To conduct a study, it is important to observe all the nuances.

Condition	Explanation
Selecting a specific age group	In 6-year-olds, the condition of baby teeth is examined; in 12-year-olds, teeth are not completely formed, but the development of caries can be assessed over time; in 15-year-olds, the condition of the periodontium is visible; 33-45 years old - judge the state of dental health in the adult population; from 65 years of age are considered to establish the volume of dental care for the elderly.
Selection of specialists conducting the study	They undergo special training to equally evaluate the results they see.
Availability of equipment	Instruments for visual inspection – dental mirror and probes (sharp angled and periodontal button); means to ensure sterility (antiseptic solution, disinfection container, disinfected cotton swabs); a map where the results of the study will be recorded.

For objectivity of observation, it is recommended to recruit an equal number of people of both sexes into the group. If the migrant population in the region of interest exceeds 30%, then the intensity and prevalence of caries in them is assessed separately from the indigenous population.

Conclusion

Caries is an insidious disease that almost everyone has. To combat it, objectively assess what is happening and competently plan the allocated funds and medical rates, statistical indicators are used.

Epidemiological research is carried out to determine the quality of care provided, plan new activities and evaluate the effectiveness of existing ones. Indicators of prevalence and intensity allow you to see the scale of the problem and adjust the tasks leading to its elimination. When carrying out prophylaxis, growth is reduced and its reduction may be noted. These values ​​can only be revealed in the dynamics of the disease over a certain period.

Indices used during dental examination. Indexes in dentistry

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

There are three types of KPU index:

• KPU of teeth (KPUz) - the number of carious and filled teeth of the subject;
• KPU surfaces (KPUpov) - the number of tooth surfaces affected by caries;
• KPUpol - the absolute number of carious cavities and fillings in the teeth.

For temporary teeth, the following indicators are used:

• kp - the number of carious and filled teeth in the temporary occlusion;
• kp - number of affected surfaces;
• checkpoint - the number of carious cavities and fillings.

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

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

• both treated and extracted teeth are taken into account;
• can only increase over time and with age begin to reflect the previous incidence of caries;
• do not allow taking into account the very initial carious lesions.

Serious disadvantages of the KPUz and KPUp indices include their unreliability when tooth damage increases due to the formation of new cavities in treated teeth, the occurrence of secondary caries, loss of fillings, and the like.

The prevalence of caries is expressed as a percentage. To do this, the number of people who were found to have certain manifestations of dental caries (except for focal demineralization) is divided by the total number of people examined in this group and multiplied by 100.
In order to assess the prevalence of dental caries in a particular region or compare the value of this indicator in different regions, the following assessment criteria for the level of prevalence among 12-year-old children are used:
INTENSITY LEVEL
LOW - 0-30%
AVERAGE - 31 - 80%
HIGH - 81 - 100%
To assess the intensity of dental caries, the following indices are used:
a) intensity of caries of temporary (baby) teeth:
index kp (z) - the sum of teeth affected by untreated caries
and filled in one individual;
index kp (n) - the sum of surfaces affected by untreated
caries and fillings in one individual;
In order to calculate the average value of the indices kp(z) and kp(p) in a group of subjects, one should determine the index for each person examined, add up all the values ​​and divide the resulting amount by the number of people in the group.
b) intensity of caries of permanent teeth:
index KPU(z) - the sum of carious, filled and removed
teeth in one individual;
index KPU (n) - the sum of all surfaces of the teeth on which
caries or filling was diagnosed in one individual. (If
the tooth is removed, then in this index it is considered to be 5 surfaces).
When determining these indices, early forms of dental caries in the form of white and pigmented spots are not taken into account.
In order to calculate the average value of indices for a group, you should find the sum of individual indices and divide it by the number of people examined in this group.
c) assessment of the intensity of dental caries among the population.
To compare the intensity of dental caries between different regions or countries, the average values ​​of the KPU index are used.

The CPITN index is used in clinical practice to examine and monitor periodontal condition.. This index records only those clinical signs that may undergo reverse development (inflammatory changes in the gums, judged by bleeding, tartar), and does not take into account irreversible changes (gingival recession, tooth mobility, loss of epithelial attachment). CPITN "does not tell" about the activity of the process and cannot be used for treatment planning.

The main advantage of the CPITN index is its simplicity, speed of determination, information content and the ability to compare results. The need for treatment is determined based on the following criteria.

CODE 0 or X means that there is no need to treat this patient.
CODE 1 indicates that this patient needs to improve his oral hygiene.
CODE 2 indicates the need for professional hygiene and the elimination of factors that contribute to plaque retention.
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.
CODE 4 can sometimes be successfully treated with deep curettage and adequate oral hygiene. Complex treatment is required.

Papillary-marginal-alveolar index (PMA) used to assess the severity of gingivitis. There are several types of this index, but the most widespread is the PMA index in the Parma modification. The number of teeth (while maintaining the integrity of the dentition) is taken into account depending on age: 6 - 11 years - 24 teeth, 12 - 14 years - 28 teeth, 15 years and older - 30 teeth. Normally, the PMA index is zero.

How well a patient monitors oral hygiene is determined by the Fedorov-Volodkina Hygienic Index. The index is recommended to be used to assess the hygienic state of the oral cavity in children under 5-6 years of age. To determine the index, the labial surface of six teeth is examined. Teeth are stained using special solutions and the presence of plaque is assessed. Determination of supra- and subgingival tartar is carried out using a dental probe. The calculation of the index consists of the values ​​​​obtained for each component of the index, divided by the number of surfaces surveyed, followed by the summation of both values.

Also common Oral Hygiene Performance Index (OHP). To quantify plaque, 6 teeth are stained. The index is calculated by determining the code for each tooth by adding the codes for each section. Then the codes for all examined teeth are summed up and the resulting sum is divided by the number of teeth:

To assess the state of occlusion it is used dental aesthetic index, which determines the position of the teeth and the state of the bite in the sagittal, vertical and transversal directions. It is used from the age of 12.

The examination is carried out visually and using a button probe. The index includes definitions of the following components:

• lack of teeth;
• crowding in the incisal segments;
• gap in incisal segments;
• diastema;
• deviations in the anterior region of the upper jaw;
• deviations in the anterior region of the lower jaw;
• anterior maxillary overlap;
• anterior mandibular overlap;
• vertical anterior slit;
• anterior-posterior relationship of molars.

The dental aesthetic index allows you to analyze each of the components of the index or group them by anomalies of the dentition and bite.

The prevalence of caries is expressed as a percentage. To do this, the number of people who were found to have certain manifestations of dental caries (except for focal demineralization) is divided by the total number of people examined in this group and multiplied by 100.

In order to assess the prevalence of dental caries in a particular region or compare the value of this indicator in different regions, the following assessment criteria for the level of prevalence among 12-year-old children are used:

Intensity level

LOW - 0-30% MEDIUM - 31 - 80% HIGH - 81 - 100%

To assess the intensity of dental caries, the following indices are used:

a) intensity of caries of temporary (baby) teeth:
index kp (z) - the sum of teeth affected by untreated caries and filled in one individual;

kp index (n) - the sum of surfaces affected by untreated caries and filled in one individual;

In order to calculate the average value of the indices bullpen) And kp(p) in a group of subjects, you should determine the index for each person examined, add up all the values ​​and divide the resulting amount by the number of people in the group.

b) intensity of caries of permanent teeth:

index KPU(z) - the sum of carious, filled and extracted teeth in one individual;

KPU index (p) - the sum of all tooth surfaces on which caries or fillings are diagnosed in one individual. (If a tooth is removed, then in this index it is considered 5 surfaces).

When determining these indices, early forms of dental caries in the form of white and pigmented spots are not taken into account.
In order to calculate the average value of indices for a group, you should find the sum of individual indices and divide it by the number of people examined in this group.

c) assessment of the intensity of dental caries among the population.
To compare the intensity of dental caries between different regions or countries, the average values ​​of the KPU index are used.

Methods for assessing oral hygiene. Oral Health Indices

Methods for assessing dental plaque

Fedorov-Volodkina Index(1968) was widely used in our country until recently.

The hygienic index is determined by the intensity of coloring of the labial surface of the six lower frontal teeth with an iodine-iodide-potassium solution, assessed using a five-point system and calculated using the formula: By Wed=(∑To u)/n

Where By Wed. - general hygienic cleaning index; To u- hygienic index of cleaning one tooth; n- number of teeth.

Staining the entire surface of the crown means 5 points; 3/4 - 4 points; 1/2 - 3 points; 1/4 - 2 points; absence of staining - 1 point. Normally, the hygiene index should not exceed 1.=

Green-Vermillion Index(Green, Vermillion, 1964). The Oral Hygiene Index Simplified (OHI-S) evaluates the area of ​​tooth surface covered by plaque and/or tartar and does not require the use of special dyes. To determine OHI-S, examine the buccal surface 16 and 26, the labial surface 11 and 31, and the lingual surface 36 and 46, moving the tip of the probe from the cutting edge towards the gum.

The absence of dental plaque is indicated as 0 , dental plaque up to 1/3 of the tooth surface - 1 , dental plaque from 1/3 to 2/3 - 2 , dental plaque covers more than 2/3 of the enamel surface - 3 . Then tartar is determined using the same principle.

Formula for calculating the index.OHI - S=∑(ZN/n)+∑(ZK/n)

Where n- number of teeth, ZN- dental plaque, ZK- tartar.

Silnes-Lowe Index(Silness, Loe, 1967) takes into account the thickness of plaque in the gingival region in 4 areas of the tooth surface: vestibular, lingual, distal and mesial. After drying the enamel, the tip of the probe is passed along its surface at the gingival sulcus. If a soft substance does not adhere to the tip of the probe, the plaque index on the tooth area is indicated as - 0. If the plaque is not visually determined, but becomes visible after moving the probe, the index is 1. A plaque with a thin to moderate layer thickness, visible to the naked eye, is assessed as 2 Intensive deposition of plaque in the area of ​​the gingival sulcus and interdental space is designated as 3. For each tooth, the index is calculated by dividing the sum of the points of 4 surfaces by 4.

The general index is equal to the sum of the indicators of all examined teeth, divided by their number.

Tartar index(CSI)(ENNEVER et al., 1961). Supra- and subgingival tartar is determined on the incisors and canines of the lower jaw. The vestibular, distal-lingual, central-lingual and medial-lingual surfaces are differentially examined.

To determine the intensity of tartar, a scale from 0 to 3 is used for each surface examined:

0 - no tartar

1 - tartar is determined to be less than 0.5mm in width and/or thickness

2 - width and/or thickness of tartar from 0.5 to 1 mm

3 - width and/or thickness of tartar more than 1 mm.

Formula for calculating the index: ZK intensity = (∑codes_of_all_surfaces)/n_teeth

where n is the number of teeth.

Ramfjord index(S. Ramfjord, 1956) as part of the periodontal index involves the determination of dental plaque on the vestibular, lingual and palatal surfaces, as well as the proximal surfaces of the 11, 14, 26, 31, 34, 46 teeth. The method requires preliminary staining with a Bismarck brown solution. Scoring is done as follows:

0 - absence of dental plaque

1 - dental plaque is present on some tooth surfaces

2 - dental plaque is present on all surfaces, but covers more than half of the tooth

3 - dental plaque is present on all surfaces, but covers more than half.

The index is calculated by dividing the total score by the number of teeth examined.

Navi Index(I.M.Navy, E.Quiglty, I.Hein, 1962).Tissue color indices in the oral cavity limited by the labial surfaces of the front teeth are calculated. Before the examination, the mouth is rinsed with a 0.75% solution of basic fuchsin. The calculation is carried out as follows:

0 - no plaque

1 - the plaque was stained only at the gingival border

2 - pronounced plaque line at the gingival border

3 - the gingival third of the surface is covered with plaque

4 - 2/3 of the surface is covered with plaque

5 - more than 2/3 of the surface is covered with plaque.

The index was calculated in terms of the average number per tooth per subject.

Turesky Index(S. Turesky, 1970). The authors used the Quigley-Hein counting system on the labial and lingual surfaces of the entire row of teeth.

0 - no plaque

1 - individual spots of plaque in the cervical area of ​​the tooth

2 - a thin continuous strip of plaque (up to 1 mm) in the cervical part of the tooth

3 - plaque strip is wider than 1 mm, but covers less than 1/3 of the tooth crown

4 - plaque covers more than 1/3, but less than 2/3 of the tooth crown

5 - plaque covers 2/3 of the tooth crown or more.

Arnim index(S. Arnim, 1963) when assessing the effectiveness of various oral hygiene procedures, determined the amount of plaque present on the labial surfaces of the four upper and lower incisors, stained with erythrosine. This area is photographed and developed at 4x magnification. The outlines of the corresponding teeth and colored masses are transferred to paper and these areas are determined with a planimer. The percentage of surface area covered by plaque is then calculated.

Hygiene Performance Index(Podshadley, Haby, 1968) requires the use of dye. Then a visual assessment of the buccal surfaces of 16 and 26 teeth, labial surfaces of 11 and 31 teeth, and lingual surfaces of 36 and 46 teeth is carried out. The surveyed surface is conventionally divided into 5 sections: 1 - medial, 2 - distal 3 - mid-occlusal, 4 - central, 5 - mid-cervical.

0 - no staining

1 - staining of any intensity is available

The index is calculated using the formula:PHP=(∑codes)/n

Clinical methods for assessing gum health

PMA Index(Schour, Massler ). Inflammation of the gingival papilla (P) is assessed as 1, inflammation of the gingival margin (M) - 2, inflammation of the mucous membrane of the alveolar process of the jaw (A) - 3.

By summing up the gum condition assessments for each tooth, the PMA index is obtained. At the same time, the number of examined teeth of patients aged 6 to 11 years is 24, from 12 to 14 years old - 28, and from 15 years old - 30.

The PMA index is calculated as a percentage as follows:

RMA = (sum of indicators x 100): (3 x number of teeth)

In absolute numbers, PMA = sum of indicators: (number of teeth x 3).

Gingival index GI(Loe, Silence ) . For each tooth, four areas are differentially examined: the vestibular-distal gingival papilla, the vestibular marginal gingiva, the vestibular-medial gingival papilla, the lingual (or palatal) marginal gingiva.

0 - normal gum;

1 - mild inflammation, slight discoloration of the gum mucosa, slight swelling, no bleeding on palpation;

2 - moderate inflammation, redness, swelling, bleeding on palpation;

3 - pronounced inflammation with noticeable redness and swelling, ulceration, and a tendency to spontaneous bleeding.

Key teeth whose gums are examined: 16, 21, 24, 36, 41, 44.

To evaluate the examination results, the sum of points is divided by 4 and the number of teeth.

0.1 - 1.0 - mild gingivitis

1.1 - 2.0 - moderate gingivitis

2.1 - 3.0 - severe gingivitis.

IN periodontal index P.I. (Russell) the condition of the gums and alveolar bone is calculated individually for each tooth. For calculation, a scale is used in which a relatively low indicator is assigned to gum inflammation, and a relatively higher indicator to alveolar bone resorption. The indices of each tooth are summed up, and the result is divided by the number of teeth in the oral cavity. The result shows the patient's periodontal index, which reflects the relative status of periodontal disease in a given oral cavity without taking into account the type and causes of the disease. The arithmetic mean of the individual indices of the examined patients characterizes the group or population indicator.

Periodontal Disease Index - PDI (Ramfjord, 1959) includes an assessment of the condition of the gums and periodontium. The vestibular and oral surfaces of the 16th, 21st, 24th, 36th, 41st, and 44th teeth are examined. Plaque and tartar are taken into account. The depth of the periodontal pocket is measured with a graduated probe from the enamel-cement junction to the bottom of the pocket.

GINGIVITIS INDEX

0 - no signs of inflammation

1 - mild or moderate inflammation of the gums, not spreading around the tooth

2 - moderate inflammation of the gums, spreading around the tooth

3 - severe gingivitis, characterized by severe redness, swelling, bleeding and ulceration.

INDEX OF PERIODONTAL DISEASE

0-3 - the gingival groove is determined no deeper than the cemento-enamel junction

4 - gum pocket depth up to 3 mm

5 - gum pocket depth from 3 mm to 6 mm

6 - gum pocket depth more than 6 mm.

CPITN (WHO) - comprehensive periodontal index of treatment need used to assess the periodontal condition of the adult population, to plan prevention and treatment, determine the need for dental personnel, analyze and improve treatment and preventive programs.

To determine the indicator, a specially designed periodontal probe is used, which has a ball with a diameter of 0.5 mm at the end and a black stripe at a distance of 3.5 mm from the tip of the probe.

In persons over 20 years of age, the periodontium is examined in the area of ​​six groups of teeth (17/16, 11, 26/27, 37/36, 31, 46/47) in the lower and upper jaws. If there is not a single index tooth in the named sextant, then all remaining teeth in that sextant are examined.

In young people under the age of 19, teeth 16, 11, 26, 36, 31, 46 are examined.

Registration of research results is carried out according to the following codes:

0 - healthy gums, no signs of pathology

1 - bleeding of the gums is observed after probing

2 - subgingival tartar is determined with a probe; the black strip of the probe does not sink into the gingival pocket

3 - a pocket of 4-5mm is determined; the black strip of the probe is partially immersed in the periodontal pocket

4 - a pocket of more than 6 mm is determined; the black strip of the probe is completely immersed in the gingival pocket.

Complex periodontal index - KPI (P.A. Leus). In adolescents and adults, teeth 17/16, 11, 26/27, 31, 36/37, 46/47 are examined.

The patient is examined in a dental chair under adequate artificial lighting. A standard set of dental instruments is used.

If several signs are present, a more severe lesion is recorded (higher score). In case of doubt, preference is given to underdiagnosis.

The KPI of an individual is calculated using the formula: KPI=(∑codes)/n

where n is the number of teeth examined.

Index for assessing dental plaque in young children (E.M. Kuzmina, 2000)

To assess the amount of plaque in a young child (from the eruption of primary teeth to 3 years), all teeth present in the oral cavity are examined. The assessment is carried out visually or using a dental probe.

The amount of plaque must be determined even if there are only 2-3 teeth in the child’s mouth.

Codes and evaluation criteria:

• 0 - no plaque
• 1 - plaque present

The individual index value is calculated using the formula:

Plaque = number of teeth with plaque / number of teeth in the mouth

Index interpretation

HYGIENE INDEX according to Fedorov-Volodkina (1971)

To determine the index, the labial surface of six teeth is examined: 43, 42, 41, 31, 32, 33

The indicated teeth are stained using special solutions (Schiller-Pisarev, fuchsin, erythrosine, and the presence of plaque is assessed using the following codes:

1 - no dental plaque was detected;

2 - staining one quarter of the surface of the tooth crown;

3 - staining half the surface of the tooth crown;

4 - staining three quarters of the surface of the tooth crown;

5 - staining the entire surface of the tooth crown.

To assess the plaque present in a given patient, add up the codes obtained from examining each of the stained teeth and divide the sum by 6.

To obtain the average value of the hygiene index in a group of children, add up the individual index values ​​for each child and divide the sum by the number of children in the group.

ORAL HYGIENE INDEX SIMPLIFIED (IGR-U), (OHI-S), J.C. Green, J.R. Vermillion (1964)

The index allows you to separately assess the amount of plaque and tartar.

To determine the index, 6 teeth are examined:

16, 11, 26, 31 - vestibular surfaces

36, 46 - lingual surfaces

Assessment of dental plaque can be carried out visually or using staining solutions (Schiller-Pisarev, fuchsin, erythrosine).

0 - no dental plaque was detected;

1 - soft plaque covering no more than 1/3 of the tooth surface, or the presence of any amount of colored deposits (green, brown, etc.);

2 - soft plaque covering more than 1/3, but less than 2/3 of the tooth surface;

3 - soft plaque covering more than 2/3 of the tooth surface.

CODES AND CRITERIA FOR EVALUATING DENTAL CALCULUS

Determination of supra- and subgingival tartar is carried out using a dental probe.

0 - no tartar was detected;

1 - supragingival tartar, covering no more than 1/3 of the tooth surface;

2 - supragingival tartar, covering more than 1/3, but less than 2/3 of the tooth surface, or the presence of individual deposits of subgingival tartar in the cervical area of ​​the tooth;

3 - supragingival calculus covering more than 2/3 of the tooth surface, or significant deposits of subgingival calculus around the cervical area of ​​the tooth.

The calculation of the index consists of the values ​​​​obtained for each component of the index, divided by the number of surfaces surveyed, and summing both values.

Formula for calculation:

IGR-U= SUM OF PLAQUE VALUES / NUMBER OF SURFACES + SUM OF STONE VALUES / NUMBER OF SURFACES

Index interpretation

Oral Hygiene Performance Index (OHP) Podshadley, Haley (1968)

To quantify plaque, 6 teeth are stained:

16, 26, 11, 31 - vestibular surfaces;

36, 46 - lingual surfaces.

If there is no index tooth, you can examine the adjacent one, but within the group of teeth of the same name. Artificial crowns and parts of fixed dentures are examined in the same way as teeth.

Examined surface of each tooth
conditionally divided into 5 sections

1. medial
2. distal
3. midocclusal
4. central
5. midcervical

CODES AND CRITERIA FOR ASSESSING DENTAL PLAQUE

0 - no staining

1 - staining detected

The index is calculated by determining the code for each tooth by adding the codes for each section. Then the codes for all examined teeth are summed up and the resulting sum is divided by the number of teeth.

The index is calculated using the following formula:

RNR = SUM OF ALL TEETH CODES / NUMBER OF TEETH EXAMINED

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