functional tests. The textbook was compiled by the staff of the Department of Dentistry FPC and PPS Dagmed Academy Instrumental and other research methods
Chapter 2^
MEANS FOR PREVENTION AND TREATMENT OF DENTAL CARIES
I CARIES- a pathological process that affects the tooth after its eruption, accompanied by demineralization of hard tissues, which subsequently
I leads to the formation of a defect in the form of a cavity.
Currently, caries is one of the most common diseases. This is primarily due to social factors: working and living conditions of people, the nature of their diet and environmental changes, insufficient fluorine content in drinking water sources, poor oral hygiene and other reasons.
The high prevalence and intensity of caries lesions require extensive prevention of this pathology.
Preventive anti-caries measures are based on knowledge of the patterns of etiology and pathogenesis of caries. It is known that the occurrence of dental caries is due to the interaction of general and local factors. The factors of the general impact include the inferiority of the diet and drinking water, various functional disorders of the organs and systems of the body, as well as the influence of extreme conditions. Local factors: dental plaque (its composition, amount), violation of the composition of the oral fluid and its properties, the presence of carbohydrate food residues on the teeth. An important role in the etiology of caries is assigned to the resistance of dental tissues, i.e. their complete structure and chemical composition.
The clinic uses a topographic classification of caries, taking into account the depth of damage to the hard tissues of the tooth. There are caries in the stage of spots (initial caries), superficial, medium and deep.
Initial caries, or caries in the stain stage, is a lesion of the enamel, in which its surface layer remains intact. The carious spot may be chalky or pigmented. With superficial caries, a defect in the tissues of the tooth is formed within the enamel; with an average caries, a defect occurs that goes beyond the limits of the enamel-dentin junction; with deep caries, a significant destruction of the dentin thickness is determined with the formation of a carious cavity, the bottom of which is separated from the tooth cavity only by a thin layer of dentin.
Treatment of the initial stages of caries in the stain stage, especially the chalky one, is carried out by remineralization. If there is a carious cavity in the tooth, it is filled.
^ 2.1. DRUGS FOR PREVENTION AND TREATMENT OF INITIAL CARIES
Regular and thorough plaque removal is known to be essential in caries prevention. For an objective assessment of the hygienic state of the oral cavity, plaque is indicated (stained) using special diagnostic dyes (indicators), which are fixed by the organic component of plaque.
^ 2.1.1. Plaque indicators
In dental practice, 0.75% and 6% solutions of basic fuchsin, 4-5% alcohol solution of erythrosine, erythrosin tablets (6-10 mg each), Schiller-Pisarev solution, 2 % an aqueous solution of methylene blue.
Magenta(Fuchsini) - the main solution of fuchsin. OK-
Raschivaet tooth plaque in raspberry color. The drug is used for rinsing.
Rp.: Fuchsini bas. 1.5
Spiritus aethylici 75% 25 ml D.S. 15 drops per l /i a glass of water (for rinsing the mouth for 20 seconds)
Erythrosine(Erythrosin) - red dye of low toxicity. Contains iodine. Produced in the form of 4-5 % alcohol solution and tablets (Mentadent C-Plague, Oga] In Einfarb Plagueindika-
Tor, Plague-Farbetabletten, etc.).
Rp.: Sol. Erythrosini 5% 15ml
D.S. Apply with a cotton swab to the surface of the teeth
Rep.: Tab. Erythrosini 0.006 N. 30
D.S. Chew 1 tablet for ^ 1 min
Fluorescein(Fluorescein) is an iodine-free plaque stain, so it can be used in patients who are sensitized to iodine. Fluorescein stained plaque is visible only under ultraviolet light. Produced under the names "Plak-Lite" ("Blendax"), "Fluorescein" 0.75 %.
^ Schiller's solution - Pisarev stains dental plaque yellow-brown. The drug is applied to the surface of the teeth with a cotton swab.
^ Kalii iodidi 2.0
Aq. destill. 40ml
M.D.S. Schiller-Pisarev solution. Apply with a cotton swab to the surface of the teeth
Methylene blues(Methylenum coeruleum) is used to detect dental plaque: 1-2% aqueous solution of methylene blue is applied to the surfaces of the teeth with a cotton swab.
Rp.: Methyleni coerulei 2.0 Aq. dcstiil. 100 ml M.D.S. To lubricate the surface of the teeth
^ 2.1.2. Fluorine compounds
Prevention and treatment of the initial stage of caries are carried out with the help of fluorine compounds. Fluorine compounds normalize mineral and protein metabolism, which creates favorable conditions for the mineralization of hard tissues of the tooth and bones of the skeleton. The appointment of fluoride preparations during the period of mineralization of hard tissues contributes to an increase in their caries resistance, which is used when carrying out preventive measures in childhood.
Fluorine compounds enter the body with water and food. The optimal amount of fluorine introduced into the body of an adult is in the range of 1.2-2.6 mg per day, and the amount of fluorine introduced into the body of a child is 1.2-1.6 mg.
To prevent dental caries, organic and inorganic fluorine compounds are used. The most commonly used sodium fluoride, potassium fluoride, tin fluoride, aminofluoride, titanium fluoride. Fluorides are prescribed topically and orally.
^ Locally use 0.05-0.2 % an aqueous solution of sodium fluoride (for rinsing, applications, electro- and phonophoresis), as well as fluorine varnish, fluoride-containing gels and toothpastes.
^ Sodium fluoride(Natrium fluoratum), when applied topically, enters into a chemical compound with one of the main mineral components of enamel - hydroxyapatite, turning it into hydroxyfluorapatite and fluorapatite, which is more resistant to acids. The formation of fluorapatite in enamel also reduces its permeability.
Solutions of sodium fluoride (0.05% and 0.2%) are prescribed as local remedies for children from 6 years of age and adults in the form of rinses. Rinsing the mouth with sodium fluoride solutions is carried out after eating and brushing teeth in the form of a passage (3 rinses for 1 min): 0.05% solution
Rum daily, one passage, 0.2 % solution - one passage in 1-2 weeks. Children of 6-9 years of age take 7.5 ml of solution (dessert spoon) for rinsing, at the age of 10 years and older - 15 ml of solution (tablespoon). Rinsing with sodium fluoride solutions is carried out for 9 months, repeating the course of treatment annually. Perhaps the simultaneous use of tablets, solutions of sodium fluoride and fluoride.
Rp.: Sol. Sodium fluorati 0.05 % 50 ml D.S. For mouth rinses
For applications use a 0.2% solution or 1 - 2 % sodium fluoride gel. Before the procedure, the surface of the teeth is thoroughly cleaned of plaque, isolated from saliva and dried. Then, loose cotton swabs moistened with a solution of sodium fluoride are applied to the surface of the teeth for 4-5 minutes. For a course of treatment 4-7 applications (2 times a year).
Rp.: Sol. Natrii fluorati 0.2% 50mf
D.S. For applications on the surface of tooth enamel or for electrophoresis (introduce from the cathode for 2-3 minutes); course 4-7 procedures
fluorine varnish(Phthorlacum) - a composition of natural resins of viscous consistency, dark yellow color, containing 2.9% fluorine. The composition of fluorine varnish includes (per 100 g): sodium fluoride (5 g), fir balm (40 g), shellac (19 g), chloroform (12 g) and ethyl alcohol (24 g). It does not dissolve in water, pH 5.25.
The fluorine varnish film is retained on the tooth surface for a long time, saturating the surface layer of the enamel with fluorine ions, which contributes to the formation of more durable and less acid-soluble fluorapatite.
To prevent caries, fluoride varnish is used in children aged 7 to 14 years. All teeth are treated with the preparation 3 times with an interval of 6 months.
As a remedy for caries in the stage of staining and hyperesthesia of hard dental tissues, fluoride varnish is applied to individual affected teeth 1-2 times a week.
Liu. The course of treatment - up to 4 applications. If necessary, after 6-12 months, a second course of treatment with the drug is carried out.
Rp.: Phthorlacum 25 ml
D.S. Apply to the surface of the tooth for 3-5 minutes
To prevent caries, fluoride varnish is used as follows. The surface of the tooth is thoroughly cleaned of plaque, wiped with a cotton swab (thorough drying is not required). Using a brush or a plastic (wooden) spatula-shaped stick, the drug is applied in a thin layer to the surface of the teeth, starting from the teeth of the lower jaw (to avoid the accumulation of saliva). Within 4-5 minutes after applying the fluorine varnish (until the varnish dries), the patient should not close his mouth. Within 12-22 hours, you should only eat liquid food and do not brush your teeth. It is recommended to cover the teeth with fluorine varnish three times with an interval of 1-2 days. After 6 months, the procedure is repeated.
For applications, 0.2 is used % sodium fluoride solution or 1-2% fluoride gel. Before application, the surface of the teeth is thoroughly cleaned of plaque, isolated from saliva and dried with swabs or air. Then, loose cotton swabs impregnated with the drug are applied to the surface of the teeth for 4-5 minutes. For a course of treatment - 3-7 applications 2 times a year.
For applications, 1-2 are recommended % sodium fluoride gel on 3% agar. When heated, the gel is applied to the thoroughly cleaned and dried surface of the teeth with a brush. When in contact with the surface of the tooth, the gel solidifies in the form of a thin film. It is not allowed to eat for 3 hours. For a course - 3-5 applications.
Holds fluoride on the tooth surface. In addition, gels can be applied using impression trays simultaneously on all teeth in one procedure, which saves time for the dentist and the patient.
When working with fluoride-containing gels, measures should be taken to minimize the ingestion of the gel by patients:
use a saliva ejector during application;
limit the amount of gel placed in each custom-made impression tray to 5-10 drops;
During the procedure, the patient should sit straight with his head tilted forward.
When working with acidic fluorophosphate gels, protective measures should be taken if porcelain prostheses are present in the oral cavity of patients, which can be destroyed by acid solutions and gels (they are recommended to be lubricated with petroleum jelly before application).
Currently, many companies produce caries-prophylactic fluorine-containing solutions of various names and compositions: Pro Fluoride M ("VOCO"), Fluocal Solute ("Septodont"), gels: Fluocal Gel ("Septodont"), Fluoridin Gel N 5 (" VOCO"), Pro Fluorid Gelex ("VOCO"), Fluor-Gel ("Blend-a-med"), Oral B Fluor-gel ("Cooper"), Elmex-gel ("Wypert"), etc.; fluorine-containing varnishes: Fluoridine ("VOCO"), Bifiuorid 12 ("VOCO"), Controcar ("Hammacher"), Duraphat ("Woelm"), Belagel Ca, P, Belagel F, etc.
The high anti-caries efficacy of acid fluorophosphate gel, which contains
dit 12,300 ppm* fluoride, and mouthwash "Fluor" (230 ppm fluoride), "Forte" (910 ppm fluoride); gels containing tin fluoride (970 and 19400 ppm fluorides), as well as ammonium fluorides (Elmex fluid, etc.).
In order to prevent caries, special polishing pastes containing fluorides are also used: Detartrine Fluoree (Septodont), Proxyt (Vivadent), etc. They are used to polish the surface of teeth 1-2 times a year as caries pro-phylactic agent.
Fluoride gels containing neutral sodium gel (5000 ppm) and stannous fluoride (1000 ppm) can be used by patients on their own as a caries prophylactic. They are recommended as a caries prevention agent for weekly use over the age of 8 years (Elmex gelee, Blend-a-med gel, etc.).
To prevent caries, a wide range of fluoride-containing toothpastes (with a fluorine concentration of 0.01 - 1%) is used: Zodiac, Karimed, Komilfo, Fluorodent, Cheburashka, Remodent, Blend-a- med", "Crest", "Blendax", "Elmex", "Signal", "Lacalut", "Binaca", "Pepsodent", "Chlorodent-fluoro-forte", "Fluorodent", "Polana", "Copadent" , Colgate, Elgy-fluor, Macleans, Aquafresh, etc.
Endogenous fluoride prevention of caries includes the introduction of fluoride into the body with drinking water, salt, milk, fluoride tablets. For mass prevention, it is advisable to carry out fluoridation of drinking water containing fluorine at a concentration of less than 0.5 mg/l. With the help of fluorine installations on the city water supply, the concentration of fluorine is adjusted to 0.8-1.2 mg/l.
For young and middle-aged children, the use of fluoridated milk gives an effect as a caries prophylactic.
The caries-prophylactic effect of fluoride has been proven.
Ppm - part per million (ppm).
Rolled table salt. The normal concentration of fluoride should be considered to be 200 mg/kg of salt when several types of salt are fluoridated (for domestic culinary purposes and for bakeries, restaurants and other catering establishments). This concentration can be increased by a factor of 2 only if only salt for domestic culinary needs is fluoridated.
The effectiveness of caries prevention with the use of fluoride tablets largely depends on the regularity of their intake.
The use of sodium fluoride tablets helps to prevent the formation of caries not only in those teeth that have erupted after the start of taking the drug, but also in those that have already erupted with an incomplete mineralization process. These tablets contain 0.0011 and 0.0022 g of sodium fluoride. They are used at the age of 2 to 14 years. The required daily dose of the drug is set depending on the age of the child and the fluoride content in the water of a particular source. Sodium fluoride tablets are taken by mouth after eating and brushing your teeth. The tablet should be chewed and held in the mouth until completely dissolved, then swallowed. It is not recommended to take drugs containing calcium at the same time.
Children aged 2 to 6 years are prescribed sodium fluoride 0.0011 g, over 6 years - 0.0022 g 1 time per day. The drug is taken daily, at least 250 days a year, annually up to 14 years of age.
The use of sodium fluoride tablets is contraindicated in areas where the fluorine content in drinking water exceeds 0.8 mg/l. Information about the content of fluorine in drinking water is obtained from the sanitary and epidemiological station.
Sodium fluoride is produced in tablets of 0.0011 and 0.0022 g, as well as in powder, from which 0.05% and 0.2% solutions are prepared.
To avoid the risk of acute fluoride poisoning, medicinal packs containing, as a rule, 200-250 tablets, should be stored out of the reach of children.
35
Rep.: Tab. Natrii fluoridi 0.0011 N. 50
D.S. 1 tablet per day (children 2-6 years old)
Rep.: Tab. Natrii fluoridi 0.0022 N. 50
D.S 1 tablet per day (children 7-14 years old)
In Poland, similar Natrium Fluoratum tablets are produced containing 0.001 g of sodium fluoride. This drug is given to children from 3 to 6 years old, 1 Uh tablets per day, from 6 to 14 years - 2 tablets per day.
Vitaftor(Vitaphthorum) - a combined preparation that includes a complex of vitamins A, C, D 2 and sodium fluoride. 1 ml of the drug contains sodium fluoride 0.22 mg, retinol palmitate (vitamin A) 0.36 mg, ergocalciferol (vitamin D 2) 0.002 mg, ascorbic acid (vitamin C) 12 mg with the addition of sorbitol and other substances.
Vitaftor is used in a complex of anti-caries therapeutic and preventive measures. It is advisable to prescribe it to children living in regions with insufficient fluorine content (less than 1 mg / l) in drinking water, and to children with signs of A- and D-hypovitaminosis.
The pharmacological properties of Vitaftor are due to the combination of vitamins A, D 2 , C and sodium fluoride in it. Vitamins A and D 2 regulate the exchange of phosphorus and calcium ions in the body, promote their absorption in the intestines and the normal development of dental and skeletal tissues. Sodium fluoride has an anti-carious effect, is well absorbed, accumulates in the tissues of teeth, bones and, to a lesser extent, in cartilage. Ascorbic acid limits the deposition of fluorine salts in tissues and thereby prevents its side effects.
Vitaftor is taken orally 10-15 minutes after meals or during meals 1 time per day daily. Children from 1 to 6 years old are given 1/2 teaspoon, from 7 to 14 years old - 1 teaspoon. The drug is used for 1 month, after a 2-week break, the course is repeated. Repeated courses are recommended 4-6 times a year with a break for the summer months.
The drug is contraindicated when the fluorine content in drinking water is more than 1.5 mg / l and with the phenomena of A- and D-hypervitaminosis.
Release form: in dark glass bottles of 115 ml.
Rp.: Vitaphthori 115 ml
D.S. 1 ^ 2-1 teaspoon 1 time per day with meals for 3 months.
^ 2.1.3. Remineralizing agents
In order to prevent and treat the initial stages of caries, preparations are used that contain the elements necessary to restore and strengthen the composition of the enamel.
The main components of remineralizing mixtures are calcium, phosphates and fluorides, which in the ionized form are part of enamel hydroxyfluorapatite and contribute to its restoration and strengthening. The concentration of ions in remineralizing mixtures should not exceed 3-5%. Enamel remineralization is carried out in two ways: with the help of applications, as well as electro- and phonophoresis.
For remineralizing therapy, a 10% solution of calcium gluconate and a 0.2% solution of sodium fluoride are used, which, alternately, are administered by application or electrophoresis.
Before the procedure, the teeth are thoroughly cleaned of plaque and dried with a cotton swab, then swabs soaked in 10% calcium gluconate solution are applied to the affected area of the enamel for 15-20 minutes, replacing them every 4-5 minutes with fresh ones.
After every third application with a mineralizing solution, a cotton swab moistened with 0.2 % sodium fluoride solution, for 2-3 minutes. After completion of the entire procedure, it is not recommended to eat for 2 hours. The course of remineralizing therapy consists of 15-20 applications daily or every other day. After completion of the course, the surface of the teeth is healthy
suitably coated with fluorine varnish. A second course of treatment is indicated after 5-6 months. It is possible to inject 10% calcium gluconate solution and 0.2% sodium fluoride solution into the surface layer of enamel using electrophoresis. Recommended for children 5 % calcium gluconate solution, as it tastes good and does not cause negative reactions in the child.
Before electrophoresis, the tooth surface is cleaned of plaque. The teeth are isolated from saliva, their surface is dried with a cotton swab or a stream of air. The passive electrode is taken in the right hand. An active electrode with turunda moistened with a solution of remineralizing liquid is placed on a pathologically altered area of tooth enamel. The current strength is up to 30 μA from the ELOS-1 or OD-2M device, the exposure time is 20 minutes. A solution of calcium gluconate (5-10%) or a solution of acidified calcium phosphate (5-10%) is introduced from the anode, a 0.2% solution of sodium fluoride - from the cathode.
It is also recommended to use Borovsky-Pakhomov remineralizing liquid. This allows you to maintain a high concentration of macro- and microelements in the carious spot throughout the course of treatment. Electrophoresis is carried out daily for 10-20 days.
Rp.: Sol. Calcii gluconatis 10% 10ml
D.t.d. N. 20inampull.
S. For applications or electrophoresis on hard tissues of the tooth (inject from the anode for 20 minutes)
Rp.: Sol. Natrii fluoridi 0.2% 20ml
D.S. For applications or electrophoresis on hard tissues of the tooth (inject from the cathode for 2-3 minutes)
A very effective means of preventing and treating the initial stages of caries is Remodent.
Remodent(Remodentum) - a preparation obtained from animal bones; contains a complex of macro- and microelements necessary for enamel remineralization. Approximate composition: calcium 4.35%, phosphorus 1.35%,
Magnesium 0.15%, potassium 0.2%, sodium 16%, chlorine 30%, organic matter 44%, trace elements up to 4%. White powder, soluble in water. Upon contact with the enamel of the teeth, the inorganic elements of the remodent diffuse intensively into its surface layer, which leads to a favorable change in the biophysical properties of the enamel - permeability and solubility in acids.
The inorganic components of the remodent actively penetrate into the pathological focus of the enamel, contributing to the restoration of its structure.
Remodent aqueous solution (3 %) apply in the form of applications on a previously cleaned and dried surface of tooth enamel for 15-20 minutes (tampons are changed 2 times). After application for 2 hours, it is not recommended to rinse your mouth and eat. The course of caries treatment in the spot stage consists of 2-28 applications (depending on the intensity of demineralization), carried out 2 times a week.
To prevent caries 3 % an aqueous solution of remodent is also used in the form of 3-5-minute mouth rinses (1-2 times a week) for 10 minutes. On average, 15-25 ml of solution is used for 1 rinse.
The shelf life of the drug is 3 years, the remodent solution is stored for no more than 14 days.
Anti-carious drug Remodent is a part of therapeutic and prophylactic varnishes, gels and toothpaste "Remodent".
Rp.: Remodenti 3.0
D.t.d. N. 10 in pulv.
S. Dissolve 1 powder in 100 ml of boiled water. For rinsing the mouth for 3-5 minutes
^ 2.1.4. Dental sealants
Prevention of initial caries of fissures and blind pits is carried out with the help of special materials - dental sealants (silants). For sealing blind pits and fissures on the chewing surface
The noses of premolars and molars use polymeric and glass ionomer materials.
Modern polymer sealants (sealants) basically contain a monomeric matrix of bisphenol A-glycidyl methacrylate (BISGMA). According to the method of polymerization, chemical and light curing dental sealants are distinguished. The composition of some polymeric sealants includes sodium fluoride, which enhances their caries-prophylactic effect (fissurit F).
For the prevention of fissure caries, modern polymeric sealants are used: Delton, Heliosea] (*Vivadent»); Estiseai ("Kulzer"); Fissurit, Fissurit F ("VOCO"); Delton ("Johnson, Johnson"); Durafill ("Kulzer"), Ultra-Seal ("Ultradent Product, Inc."); Apollo Seal (DMDS)Hnp.
Glass ionomer cements are also widely used for sealing fissures and pits. The use of glass ionomer materials as silants does not require preliminary acid etching. In addition, fluorides, which are part of glass ionomer cements, have a caries-prophylactic effect.
To seal fissures and blind pits, both light-curing glass ionomer cements (Ionoseal, Basik L) and chemically curing cements (Ionobond, Aqua Ionobond; lonofil, Aqua Ionofil, Argton, etc.)
^ 2.2. PREPARATIONS FOR THE TREATMENT OF CARIES BY THE FILLING METHOD
2.2.1. Therapeutic pads for deep caries
For the treatment of deep caries, medical pads based on calcium hydroxide are mainly used.
Materials containing Ca(OH) 2> have a pronounced antimicrobial, odontotropic and anti-inflammatory effect.
Calmecin- powder containing calcium hydroxide, zinc oxide, human blood plasma and sulfacyl sodium (albucid sodium). The liquid that is part of the therapeutic pad contains an aqueous solution of sodium carboxymethylcellulose. To prepare a gasket from Calmecin, 2-3 drops of this liquid are applied to a dry glass plate and the powder is added to it in small portions until a homogeneous plastic soft mass is obtained. Curing time of Calmecin 1-2 min. Due to the sharply alkaline reaction (pH "12), the drug has a pronounced anti-inflammatory effect.
Kalyshdont- ready-made paste used for medical pads with deep caries. The drug has an antimicrobial effect, increases the ability of the pulp to regenerate and stimulates the formation of secondary dentin.
Calcidont is available in a 9 g syringe. After each use, the syringe should be tightly closed, since the paste is hygroscopic.
For the treatment of deep caries, chemical-curing medical pads based on calcium hydroxide are used: Septocalcine ultra, Hypocal, Calci-cur, Calcimol, Caicipulpe, Reogan, Calxyl, Dykal, Hydrex, Keerlife, Reocap, etc., compatible with all filling materials.
Calcimol LC is a light-curing preparation containing calcium hydroxide, which has an anti-inflammatory, bactericidal effect and stimulates the formation of replacement dentin. When using Calcimol LC therapeutic pads, materials containing eugenol should not be used.
Septokal L.Ts.(Septocal L.C.) is a light-curing therapeutic pad containing calcium hydroxyapatite and fluorine. The photopolymerization time is 20 s.
^ 2.2.2. Materials for temporary fillings and linings
Temporary filling materials are used to fix drugs in the cavity
Tooth in the treatment of uncomplicated and complicated caries.
^ Zinc sulfate cement - the most common material for temporary fillings. Received the name "Artificial dentin", abroad it is called "Fletcher". Zinc sulfate cement powder is composed of sulfate, zinc oxide and white clay. Cement hardening occurs when the powder is mixed with water on the rough side of the glass plate.
Zinc sulphate cement powder mixed with eugenol is called dentine paste. It hardens at body temperature within 20-40 minutes. Dentin paste cannot be used to isolate liquid medicinal substances, as well as a gasket for a permanent filling.
Artificial dentin and dentine paste are mainly used as temporary fillings.
Rp.: Zinci oxydi 66.0 Zinci sulfatis 24.0 Bolialbae 10.0
M.D.S. For dressings (artificial dentin powder)
Rp.: Aq. destill. 10ml
D.S. For the preparation of artificial dentin fillings
Rp.: Dentin paste 50.0
D.S. For temporary fillings
Tempopro- artificial dentine in the form of a paste made on the basis of zinc sulfate cement. The hardening of the paste occurs within 2-3 hours. It is used to cover drugs in carious cavities of the tooth, as well as temporary fillings.
^ Zinc phosphate cements used for fixing various types of fixed dentures, orthodontic appliances, pins and as an insulating pad to protect the pulp.
Zinc phosphate cements are produced by mixing
Powder and liquid. Zinc phosphate cement powder is a multicomponent mixture of oxides and salts. Its main component is zinc oxide. The liquid that is part of the phosphate cement is an aqueous solution of orthophosphoric acid, partially neutralized with aluminum oxide hydrate and zinc oxide.
The medical industry produces zinc phosphate cements of the following names: Phosphate cement, Visphate cement, Unifas and Phosphate containing silver. Foreign analogues: HY-Bond, Tena-cin, Fixodont Pius.
In addition, bactericidal cements are produced, which are phosphate cements modified by the addition of bactericidal substances (CuO, Cu 2 0, AgCl, Cul, etc.). These cements are used for filling temporary teeth.
Rp.: Phosphate cement 50.0
D.S. Material for insulating gaskets, fixation of crowns, canal filling
Knead the powder with liquid on a thick smooth glass plate with a chrome or nickel-plated spatula. The optimal ratio of powder and liquid is from 1.8 to 2.2 g per 0.5 ml of liquid for different brands of phosphate cements. The liquid is taken with a pipette or glass rod. The amount of powder taken is divided into 4 parts, SCH part is divided in half V% part - again in half. First, mix 1/4 of the powder with the liquid. Having obtained a homogeneous mass, add successively, mixing thoroughly, 1/4, i / g and V\(, fractions of the powder. The mixing time should not exceed 1.5 minutes. The criterion for the readiness of the cement mass: when the spatula is torn off, the mass does not stretch, but breaks off, forming teeth no more than 1 mm. Do not add liquid to a densely mixed mass.
^ Polycarboxylate cement. The cement powder consists of zinc oxide with the addition of MgO, CaCl 2, Ca 3 (P0 4) 2> Ca (OH) 2. The liquid is 30-
50% viscous solution of polyacrylic acid. Carboxyl groups form chemical bonds with zinc oxide and calcium in enamel and dentin, which ensures high adhesion of the material.
Polycarboxylate cement has low toxicity; at the time of its hardening, the pH value is close to neutral (6.5-7.0).
Apply polycarboxylate cement for fixing crowns, inlays, bridges and pins, orthodontic appliances; as an insulating lining under fillings made of cement, amalgam, plastic; for filling temporary teeth.
To prepare a filling or lining from polycarboxylate cement, powder and liquid are taken in a ratio of 1.5: 3.1. Mixing must be done on a plate that does not absorb water (glass, thick paper). The powder is introduced into the liquid in large portions. The duration of mixing should not exceed 20-30 s. In order to maximize the adhesive properties of the material, it should be applied within 2 minutes.
Polycarboxylate cement is produced under the names: Poly-C, Durelon, Carbocemeni, HY-Bond, Sel-fast, water-mixed polycarboxylate cement - Aqualux ("VOKO"), Orthofix R.
Zinc-eugenol cement is formed by mixing zinc oxide and eugenol. The drug has antiseptic and some analgesic properties. According to its antimicrobial activity, zinc-eugenol cement approximately approaches calcium hydroxide preparations.
After mixing zinc oxide and eugenol on the matte surface of a glass plate, the cement hardens slowly over 10-12 hours. The preparation has a low strength. They are used as insulating pads, temporary fillings, as well as for filling root canals. Zinc-eugenol cement cannot be used as a lining when filling with composites, since eugenol disrupts the process of their polymerization and thereby worsens the quality of fillings.
Zinc-eugenol cement can be made ex tempore or commercially available ready-made forms (Provicol, 1RM, Fynal) can be used.
Rp.: Zinci oxydi 1.0 Eugenolii q.s. M.f. pasta D.S. Gasket for deep caries
^ 2.2.3. Materials for permanent fillings
According to their physical properties, permanent filling materials can be divided into three groups: cements, materials for metal fillings and polymers.
2.2.3.1. cements
As a material for permanent fillings, silicate, silicophosphate and ionomer cements are used.
silicate cements. The domestic industry produces Silicium, Silicin-2. Foreign analogues: Silikap, Alumodent, Fritex. The main ingredient of the powder is silicon oxide. Silicate cement liquid - an aqueous solution of phosphoric acid, additionally containing zinc, aluminum and magnesium phosphates. The introduction of fluoride compounds into the composition of silicate cement gives it anti-caries properties and reduces the likelihood of developing secondary caries.
Rp.: Silicin-2 50.0
D.S. For permanent fillings
The filling mass is prepared by mixing the powder with liquid on a smooth glass plate with a plastic spatula. The optimal ratio of powder and liquid varies for different brands from 1.25 to 1.55 g of powder per 0.4 ml of liquid. When mixing, the powder is added to the liquid in large portions. Immediately inject half the dose of powder,
Then 2-3 servings - the rest of the amount. Setting time of the cement test - up to 1 min.
Silicate cements have a significant toxic effect on the dental pulp, have poor adhesion and insufficient mechanical strength (brittle), so they are used for filling carious cavities of classes I and III. An insulating gasket is required.
^ Silicophosphate cements. In terms of its physicochemical properties, silicophosphate cement occupies an intermediate position between phosphate and silicate cement. Silicophosphate cement has better adhesion than silicate; its toxic properties are less pronounced. Used for filling cavities I and III classes. In the treatment of medium and deep caries, Sililont is used with an insulating gasket.
Industry produces silicophosphate cements: silidont and silidont-2. Foreign analogues of silicophosphate cement: Aristos, Lumicon, Fluoro-Thin.
^ Glass-filled cements are a powder-liquid system. The powder consists of aluminosilicate glass with a certain ratio of silicon, aluminum and fluorine. Liquid - most often 50 % polyacrylic acid solution. There are also glass-lined cements kneaded with water; in this case, distilled water is used as the liquid for the cement.
Glass-nonomer cements are harmless to tooth tissues and do not irritate the pulp. During the curing of the material, free carboxyl groups are formed that can bind with calcium in the hard tissues of the tooth, resulting in high adhesion of the material.
Fluorides, which are part of glass ionomer cements, ensure the supply of fluorine to the hard tissues of the tooth adjacent to the filling, providing an anti-caries effect.
Glass-nonomer cements are highly acid sensitive. This property is used to improve the connection of the composite with a gasket made of
Glass ionomer cement, for which it is acid etched.
The glass ionomer cement is kneaded on special paper plates for 30-40 s. The hardening time of the material is on average 3 minutes.
Glass ionomers are chemical, light and combined curing.
Depending on the purpose, glass-nonomer cements are divided into the following groups.
L For filling carious cavities of I, III and V classes, wedge-shaped defects and enamel erosion - "Jonofil", "Aqua lonofil", "Chem Fil Superior", "Chem Flex", "Chelon Fil", "Glasionomer", "Legend" , "Ketas Fil", "Ketac-Molar", "Legend Silver", "Fuji II", "Fuji HLC", "Fuji IX GP", "Argion Molar", "Jonofil Molar".
For filling all classes of carious
cavities of milk teeth and sealing of fissures
permanent teeth - "lonofil", "Aqua lonofil", "Ar
gion", "Ionobond", "lonoseal", etc.
A For applying insulating gaskets and creating foundations for restoration - Fuji-I, Argion, Aqua Ionobond, Base Line, Ionobond, lonoseal, Chem Rex, Lining Cement.
A For fixation of pins and orthopedic structures - "OrthofixS", "lonofil", "Fuji-1", "Fuji Plus", "Aqua Meron", "Metop", "Aqua Cem", "Aqua lonofil", "Ionofix".
For filling root canals - "Student", "Ketac-Endo".
When working with glass ionomer cements, the following rules should be strictly observed:
the correct ratio of liquid and powder;
close the bottle with the powder tightly with a lid, as it is very hygroscopic;
before taking the right amount of powder with a measuring spoon, shake the bottle well to loosen the powder; since it tends to compact;
avoid contact with eugenol-containing drugs;
strictly observe the powder-liquid ratio, since its violation can cause a decrease in the strength of the seal and an increase in its solubility in the oral fluid;
after applying a glass ionomer filling, cover it with a special Final Varnish varnish, which protects the filling from exposure to oral fluid during the curing process and improves the quality of the filling.
Composite filling materials (composites). The mechanism of curing of composite materials is the process of converting a monomer into a polymer (polymerization). The mechanism of polymerization, or curing, of fillings from composite materials can be chemical or light, in connection with which composites of chemical and light curing are distinguished.
For chemically cured materials, the polymerization process begins when a catalyst, benzoyl peroxide, and an activator, an aromatic quaternary amine, are mixed. Therefore, chemically cured composite materials are always two-component systems (paste - paste or powder - liquid), one of which contains a catalyst, the other - an activator.
Light-curing composite materials are a one-component system, which includes an activator and a catalyst. The activation of the polymerization process is caused by a light beam of a photopolymerizer, which is directed to the surface of the seal.
Light-curing composites, due to the absence of a time limit when working with them, have an advantage over chemically cured materials, since they allow the doctor to model the filling for the required amount of time to obtain the desired result.
Most of the existing composite materials basically contain a BISGMA monomeric matrix synthesized as a result of the combination of bisphenol-A and glyidyl methacrylate. Some modern composites contain urethane dimethacrylates as a base.
The most important component of composite materials, which determines their main properties, is a mineral or inorganic filler, which is represented by microparticles of crystalline quartz, silicon compounds, various types of glass, and diamond dust.
Depending on the particle size of the mineral filler, composite materials are divided into the following groups.
^ Macrofilled composites, or macrophiles. They contain particles of inorganic filler ranging in size from 2 to 30 microns. The materials of this group are characterized by sufficient strength, but they are poorly polished, which leads to a discoloration of the fillings and the formation of a microbial plaque that causes secondary caries and gingivitis. In this regard, macrophiles are used only for filling cavities of classes I and II of the chewing group of teeth. Macrophiles are not used for the restoration of hard tissues of the tooth. The materials in this group include Evicrol, Adaptic, Consise, Heliomolar, Sure Fil, etc.
^ Microfilled composites, or microfilaments. They have a particle size of the mineral filler of 0.02-0.04 microns. Microfills are well polished and allow to achieve a good cosmetic effect of the filling, but they are not strong enough. They are used to carry out the restoration of the frontal group of teeth in the presence of small defects in hard tissues. Microfilament composites include materials: Isopast, Helioprogress, Silux Plus, etc.
^ Hybrid composites, or hybrids. Universal composite materials used for all types of restoration work. Hybrid composites contain a microfilled matrix with the addition of macro-
and filler microparticles ranging in size from 0.05 to 2.0 microns. The hybrid group includes the following materials: DeguftH, Compodent, Brilliant, Prisma-Fill, Den-Mat, Alfacomp, Charisma, Tetric, Prisma TPH, Polofil, Arabesk, Herculite XR, Hereulite XRV, Z-100, Spectrum TPH, Prodigy, Apollo and etc.
Among hybrid materials, a separate group is made up of finely dispersed hybrids with ceramic filler, which accounts for about 80% of the volume. The materials are very durable, plastic, well modeled. They have good color gamut, radiopacity. In the process of their polymerization, fluorides are released into the surrounding hard tissues, which have a caries-prophylactic effect. This is Tetric Ceram. Te Economy. Recommended for all types of restoration
Compomers are materials that are a combination of a hybrid composite and glass ionomer cement. Representatives of this group are Dyract, Dyract AP and Compoglass. Compomers have good adhesion, as they form a chemical bond with hard tooth tissues, are convenient and easy to use, have good aesthetic qualities, and are biologically compatible with tooth tissues. In the process of polymerization, fluorides are released, which enter the hard tissues of the tooth adjacent to the filling, preventing the formation of secondary caries. The technology of working with compomers is fundamentally different from working with composite materials: acid etching is not required, since the material enters into a chemical bond with the tooth tissues.
Compared to composite materials, compomers are less durable. They are recommended for restoring class III and V cavities, filling erosions, wedge-shaped defects, as well as insulating gaskets.
Dyract AP has improved mechanical properties compared to Dyract, so it can be used for all types of restoration work.
2.2.3.3. Metal filling materials
Amalgam- an alloy of metal with mercury. There are silver and copper amalgams.
Silver amalgam is an alloy consisting mainly of silver and tin with a small amount of copper. It is used for filling cavities of I, II and V classes. Silver amalgam has high strength, plasticity, resistance to moisture, and is not destroyed by saliva in the oral cavity. Its disadvantages include poor adhesion, high thermal conductivity, volume change (shrinkage) and the presence of mercury in its composition, which, if the material preparation technology is violated, can have a toxic effect on the patient's body and dental office staff. However, compliance with the necessary requirements for storage, preparation and handling of amalgam completely excludes the possibility of its toxic effect. The most important condition for safe work with amalgam is the correct dosing of mercury and powder, which is guaranteed by the industrial production of the drug in capsules (single-chamber or two-chamber). Powder and liquid are mixed in special amalgam mixers. To work with amalgam, special tools are used: amalgam tribrach, amalgam plugger, trowel, etc.
Improving the composition of the silver amalgam goes along the path of increasing the content of copper in it and creating finely dispersed spherical particles of the silver alloy, which reduces ?
In dental practice, silver amalgam of domestic production is used: SSTA-01, SSTA-43, as well as silver amalgam in capsules SSK-68, 5-01, amadent with a minimum content of the gamma-2 phase (at 2 ).
Rp.: Silver amalgam 50.0
D.S. For making permanent fillings
Foreign firms produce silver amalgam (Amalcap) in encapsulated form. Amalcap is used for filling small carious cavities.
Amalcap plus non-gamma-2, used for filling medium and large carious cavities, is produced by Vivadent. Silver amalgam Septalloy non-gamma-2 NG 50 and NG 70 is manufactured by Septodont.
^ copper amalgam produced by the domestic industry: SMTA-56.
Copper amalgam has high strength, ductility, tight marginal fit. However, it has disadvantages: it turns black, and also corrodes under the influence of acids in the oral cavity.
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.
To study the hygienic state of the oral cavity is widely used Fedorov-Volodkina index. The hygiene 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 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 is passed 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. With the help of the hygienic index Silness-Loe evaluate:
A. Plaque area
B. plaque thickness
C. microbial composition of plaque
D. amount of plaque
E. plaque density
6. To assess the hygienic condition of the oral cavity in children under 5-6 years old, the following index is used:
B. Green-Vermillion
D. Fedorova-Volodkina
7. An index is used to assess plaque and tartar:
B. Green-Vermillion
D. Fedorova-Volodkina
8. A solution consisting of 1 g of iodine, 2 g of potassium iodide, 40 ml of distilled water is:
A. Lugol's solution
B. magenta solution
C. rr Schiller-Pisarev
D. solution of methylene blue
E. solution of trioxazine
9. A good level of oral hygiene according to Fedorov-Volodkina corresponds to the following values:
10. Satisfactory level of oral hygiene according to Fedorov-Volodkina
match the values:
11. The unsatisfactory level of oral hygiene according to Fedorov-Volodkina corresponds to the values:
12. Poor oral hygiene according to Fedorov-Volodkina corresponds to the following values:
13. A very poor level of oral hygiene according to Fedorov-Volodkina corresponds to the values:
14. To determine the Fedorov-Volodkina index, stain:
A. vestibular surface of the anterior group of teeth 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 staining of glycogen).
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.
Schiller-Pisarev solution:
Composition: potassium iodide - 2.0 g, crystalline iodine - 1.0 g, distilled water - 40.0 ml. Plaque staining method: application with a cotton ball.
Staining mechanism: iodine + glycogen polysaccharides = yellowish-pink staining.
Lugol's solution:
Composition: potassium iodide - 2.0 g, crystalline iodine - 1.0 g, distilled water - 17 ml.
The method and mechanism are the same as in the previous dye.
Lugol's solution with glycerin:
Composition: potassium iodide - 2.0 g, crystalline iodine - 1.0 g, glycerin - 94.0 g, distilled water - 3 ml.
Methylene blue:
Composition: 1% aqueous solution.
Mechanism: sorption: blue-blue staining.
Color tablet:
Ingredients: erythrosin red,
Method: chew the tablet.
Mechanism: sorption: dirty red color.
6% alcohol solution of fuchsin basic:
Composition: basic fuchsin - 1.5 g, 70% ethyl alcohol - 25 ml.
Method of staining: 15 drops in a glass of water 0.75%, vigorous rinsing of the mouth for 30 seconds, excess dye is removed by rinsing the mouth with water.
Mechanism: sorption: color from pink to crimson (Fig. 4).
Rice. 4. Soft plaque stained with dye
Plaque calcification leads to the formation of tartar (Fig.5,6 ) , solid deposits of various consistency and color. Calcium phosphate crystals that are deposited within the plaque may be closely associated with the enamel surface. Sometimes, especially in the presence of demineralization, it is difficult to determine where the enamel ends and the stone begins. For the formation of supragingival calculus, mainly minerals from saliva are used, subgingival calculus - from the gingival fluid. The organic part of the stone is a protein-polysaccharide complex, including epithelial cells, leukocytes, microorganisms, food debris.
Stone deposition, sometimes of considerable thickness, occurs both in the subgingival and supragingival regions. Calcification begins in plaque, which is present on the teeth for at least a few days.
Fig. 5. Tartar 6. Tartar
supragingival calculus most often localized in the region of the lower frontal teeth and buccal surfaces of the upper molars, where the ducts of the salivary glands open. In the absence of hygienic care, the formation of a stone occurs on the teeth that are not involved in the act of chewing. The color of the stone (white, yellow, brown) depends on the effects of food products, nicotine, as well as oxides of iron, copper and other substances, has a white or yellowish color, clay or solid consistency.
Supragingival calculus is visible to the naked eye. When exposed to a special tool, it is easily separated from the surface of the tooth.
Subgingival calculus usually hard and dense, revealed only by probing. Usually it is dark brown with a greenish tint, it is formed on the neck of the tooth within the gingival groove, on the root cement, in the periodontal pocket. The calculus encircles the neck of the tooth, often forming projections, and is firmly attached to the underlying surface.
If a patient develops a significant amount of tartar, this may be due to a decrease in the concentration of pyrophosphate, an inhibitor of tartar formation, or the absence of a specific salivary protein that prevents calcium phosphate precipitation and crystal growth.
999 06/18/2019 4 min.Periodontal diseases are widespread, so it is necessary to use advanced methods to make the most accurate diagnoses, differentiating one pathology from another. For this reason, various periodontal indices have been developed that allow you to control the dynamics of pathology development over a given time period, assess the prevalence and depth of the pathological process, and compare the effectiveness of different treatment methods. This review will focus on such a research method as the Schiller-Pisarev test, its advantages, disadvantages and features.
Determination of the diagnostic method - the Schiller-Pisarev test in dentistry
The high prevalence of periodontal pathologies and the need for their objective diagnosis in dentistry have led to the emergence of a whole set of indices. These indices are aimed at controlling the dynamics of the disease during a certain time period, assessing the depth and extent of the pathological process, allow you to compare the effectiveness of the therapeutic methods used, and process the results mathematically.
Periodontal indexes are of several types - complex, irreversible, reversible.
Reversible indices assess the dynamics of the pathological process and the effectiveness of the treatment methods used. They are calculated taking into account the indicators, the depth of the pockets, the mobility of the teeth. Irreversible characterize the degree of bone tissue resorption, gum atrophy. Complex ones allow for a comprehensive assessment of the condition of periodontal tissues.
The Schiller-Pisarev test suggests lifetime coloring of gum glycogen - the content of this component increases several times with. That is, intense staining of the gums indicates that it is inflamed. You can use the test, including after the completion of the course of treatment and to draw up a further scheme of actions.
Advantages and disadvantages
An important component of implantation at all stages is an accurate index assessment of the state of peri-implant tissues, implants and supported prostheses. The Schiller-Pisarev test is quite effective and allows you to diagnose a wide range of conditions - these are periodontal destruction, the amount of tartar, plaques, the need for certain therapeutic measures and their volume.
The ratio of the elements of the implant and adjacent tissues, its difference from the natural tooth can make complex periodontal studies impossible.
The Schiller-Pisarev test is quite accurate and objective, it has two interpretations. The first is visual, based on the nature of the staining of the gums, the second is numerical, that is, index. The main problem of the technique is that dental indexes of 30-50 years ago do not meet the current needs of modern implantology.
That is, they can be used, but when interpreting the results, it will be necessary to take into account the full list of current changes and improvements in the field of prosthetics. At the same time, it is the Schiller-Pisarev test that is considered the most informative of all similar diagnostic methods and allows the most successful adaptation of the results to the conditions of endosseous implantation. However, the conditionality of numerical values still does not disappear anywhere, since diagnostics are carried out using markers, and not high-precision digital equipment. Modern researchers say that the Schiller-Miller test is still relevant, but should be used with certain modifications and clarifications.
How is the procedure carried out
The essence of the Schiller-Pisarev test is to lubricate the gums with a solution of iodine and potassium. As a result, areas with deep lesions of the connective tissues are stained - this is due to the accumulation of large amounts of glycogen in the areas of inflammation. Samples are repeated from time to time - if the treatment is carried out correctly, the condition of the gums will improve, and the inflammation will subside or disappear altogether. That is, if the therapy is correct, then repeated samples should be weakly positive or negative.
Staining of the gums is due to the high amount of glycogen. When the inflammation subsides, there is less glycogen, and the tissues stop staining intensely. Thus, the intensity and degree of development of the disease is determined.
Solution composition
To take Schiller-Pisarev samples, the composition of the solution is used in the following proportions:
- crystalline iodine - 1.0;
- potassium iodide - 2.0;
- distilled water - 40.0.
Before using a therapeutic and prophylactic toothpaste (, Parodontol), the gum mucosa is lubricated with a special solution, then the degree of staining is determined, the data obtained are recorded in the history of the disease. Control - after 1, 2, 3, 6 and 12 months.
Result: calculation of the index, assessment of the condition of the gums
The Schiller-Pisarev test for the purpose of objectification is expressed in numbers (points). The color of the papillae is estimated at 2 points, the edges of the gums - 4, the alveoli of the gums - 8 points. The resulting total is then divided by the number of teeth in the examination area. That is, the calculation formula is as follows:
Iodine value = Sum of scores for each tooth/Number of teeth examined.
The result is the iodine number in points. Evaluation of results by points:
- weak inflammation - up to 2.3 points;
- moderate inflammation - 2.67-5.0 points;
- severe inflammation - 5.33-8.0 points.
Also, the index of peripheral circulation (abbreviated IPC) is determined separately - taking into account the ratio of the time of resorption of hematomas that appeared under vacuum and the resistance of gingival capillaries. Test indicators are evaluated in points, their ratio is expressed as a percentage. The index is calculated using the following formula:
- resistance of gingival capillaries (points);
- the period of resorption of hematomas (points).
Based on the index indicators, the functional state of the peripheral circulatory system is assessed. IPC from 0.8 to 1.0 is considered normal, 0.6-0.7 is a good condition, 0.075-0.5 is satisfactory, from 0.01 to 0.074 is a state of decompensation. You might be interested to know
Soft plaque is clearly visible to the eye, easily collected with a probe, and actively absorbs dyes. Soft plaque may not be visible immediately. Therefore, for its detection, preliminary staining with contrasting dyes is necessary. The use of various dyes makes it possible to detect the presence of dental deposits and the places of their greatest accumulation.
One of the criteria in assessing oral hygiene is an indicator that informs about the size of the surface of the tooth crown covered with plaque. Since dental deposits are usually colorless, they are determined using dyes (Bismarck brown, basic fuchsin red solution, Lugol's solution, fluorescent sodium solution, etc.)
The use of various dyes makes it possible to detect the presence of dental deposits and the places of their greatest accumulation. These substances can be used both for individual control by the patient himself, and for determining the level of oral hygiene by a doctor.
Dyes for personal use are, as a rule, either solutions for rinsing the mouth, or staining tablets for dissolution or chewing. According to the intensity and location of staining, a person himself can adjust his method of cleaning his teeth. This is also helped by the use of individual dental mirrors with or without illumination.
Dyes for medical use are usually solutions for application directly to the surfaces of the teeth using swabs or impregnated beads.
Means for indicating plaque are used:
For the purpose of demonstrating plaque and hard deposits on the teeth.
To evaluate the effectiveness of professional hygiene.
For teaching daily oral hygiene.
To detect plaque in hard-to-clean places. What to choose to identify plaque in a given situation depends on the doctor.
There are a number of substances that are indicators of dental plaque. Erythrosin tablets and solutions stain dental plaque red. Their disadvantage is the simultaneous staining of the oral mucosa. After treatment with sodium fluorescein, dental deposits acquire a yellow glow when irradiated with a special light source, without staining the gum. Combined solutions have been developed to determine the age of dental plaque. So, when treated with such a solution, an immature (up to 3 days) dental plaque turns red, and a mature one (over 3 days) turns blue. Preparations based on iodine, fuchsin, Bismarck brown can be used as coloring agents. Examples of coloring agents are Dent tablets (Japan), Espo-Plak (Paro), Red-Cote liquid and tablets (Butler), Plaque test (Vivadent) - indicator liquid for visual detection of plaque under halogen light. Staining agents can be supplied as impregnated beads to treat tooth surfaces.
Plaque indicators
In dental practice, 0.75% and 6% solutions of basic fuchsin, 4-5% alcohol solution of erythrosin, erythrosin in tablets (6-10 mg each), Schiller-Pisarev solution, 2% aqueous solution of methylene blue.
Fuchsin (Fuchsini) - the main solution of fuchsin. Colors dental plaque in crimson color. The drug is used for rinsing.
Rp.: Fuchsini bas. 1.5
Spiritus aethylici 75% 25 ml D.S. 15 drops per 1/2 cup of water (to rinse the mouth for 20 seconds)
Erythrosin is a red dye of low toxicity. Contains iodine. Available in the form of a 4-5% alcohol solution and tablets (Mentadent C-Plague, Oga] In Einfarb Plagueindikator, Plague-Farbetabletten, etc.).
Rp.: Sol. Erythrosini 5% 15ml
D.S. Apply with a cotton swab to the surface of the teeth
Rep.: Tab. Erythrosini 0.006 N. 30
D.S. Chew 1 tablet for 1 minute
Fluorescein is a plaque stain that does not contain iodine, so it can be used in patients who are sensitized to iodine. Fluorescein stained plaque is visible only under ultraviolet light. Produced under the names "Plak-Lite" ("Blendax"), "Fluorescein" 0.75%.
Schiller's solution - Pisarev stains the dental plaque in a yellow-brown color. The drug is applied to the surface of the teeth with a cotton swab.
Rp.: lodi 1.0
Kalii iodidi 2.0
Aq. destill. 40ml
M.D.S. Schiller-Pisarev solution. Apply with a cotton swab to the surface of the teeth
Methylene blue (Methylenum coeruleum) is used to detect dental plaque: a 1-2% aqueous solution of methylene blue is applied to the surfaces of the teeth with a cotton swab.
Rp.: Methyleni coerulei 2.0 Aq. dcstiil. 100 ml M.D.S. To lubricate the surface of the teeth
Lugol's solution:
Compound:
KI - 2.0 g
I crystalline - 1.0 g
distilled water - 17 ml
The method and mechanism are the same as in the previous dye
Disclosing Solution (60ml) - How to use: Prepare a solution: 10 drops of the indicator per 30 ml of water. Rinse your mouth. Do not swallow! Stained areas indicate the presence of bacterial plaque. Perform additional cleaning of problem areas.
Caterol - Plaque indicator (dental plaque), liquid for removing dental deposits and cleaning teeth.
KATEROL - an indicator of dental plaque (plaque), a preparation for removing dental plaque and cleaning teeth.
Ingredients: hydrochloric acid, iodine, acetone, excipients. Properties: Caterol softens calculus and destroys supragingival plaque, facilitating subsequent mechanical removal with instruments.
Caterol also helps to detect plaque and calculus by turning them yellow.
Contraindications: Allergy to iodine or its derivatives.
Instructions for use.
Using a dense cotton ball soaked with Caterol and well wrung out, carefully rub the calculus, trying to avoid contact with the gums as much as possible.
Wait a few seconds for the stone to become soft before mechanical.
Curaprox tablets - Colors old plaque blue and new plaque red. Ideal for home use. Each tablet is individually packaged.
Liquid Curadent Curadent for the indication of plaque - a two-color liquid that reveals plaque. Old plaque stains blue, and fresh plaque red. (60 ml - 1,615 rubles).
Plaque Agent Docdont) - mouthwash to detect plaque (500 ml -400 rubles)
The conditioner is suitable for both adults and children.
The rinse does not contain erythrosin, therefore it is successfully used in both adults and children. This method of detecting plaque is especially suitable for children, since they cannot always assess whether they have carried out the process of cleaning their teeth correctly. And if you rinse your mouth with this solution before that, it will be possible to monitor the quality of cleaning.
Recommendations: Use by children under 12 years of age should be supervised by an adult. Pour 10 ml of mouthwash into a measuring cup, rinse your mouth for 30 seconds, spit it out. Carefully clean the blue-colored areas with a toothbrush and paste.
Plaquetest tablets for the detection of plaque
Plaquetest tablets for the detection of plaque. Old dental deposits are stained dark blue, new ones - lilac-red.
To test: put the tablet on the tongue (half is enough for children), chew and spread over the entire dentition with the tongue. Spit it out - done! The color is easily removed with regular brushing.
Ingredients: lactose, magnesium stearate, silicon dioxide, meadow mint, CI 42090 (food color), CI 45410 (food color).
Dyes to detect plaque
1. Schiller-Pisarev solution:
Composition: KI - 2.0 g.
Crystalline iodine - 1.0 g.
Distilled water - 40.0 ml
Plaque staining method: application with a cotton ball.
Staining mechanism: iodine + glycogen polysaccharides = yellowish pink staining
2. Lugol's solution:
Ingredients: KI - 2.0 g
Crystalline iodine - 1.0 g
Distilled water - 17 ml
The method and mechanism are the same as in the previous dye
3. Methylene blue: Composition: 1% solution
Mechanism: sorption: blue-blue staining
4. Coloring tablet: Ingredients: erythrosin red
Method: chew the tablet. Mechanism: sorption: dirty red color
5. 6% alcohol solution of fuchsin basic:
Ingredients: basic fuchsin - 1.5 g, 70% ethyl alcohol - 25 ml
Coloring method: 15 cap. in a glass of water 0.75%, vigorous rinsing of the mouth for 30 seconds. excess dye is removed by rinsing the mouth with water. Mechanism: sorption: color from pink to raspberry
