Schiller Pisarev index in dentistry. Methods of clinical and epidemiological assessment of periodontal condition. Instrumental and other research methods

Schiller-Pisarev test

The Schiller-Pisarev test is used to determine the intensity of gingival inflammation. The test is based on the detection of glycogen content in the gums, the content of which increases during inflammation due to the lack of keratinization (ensuring the protective function of the skin from external influences) of the epithelium. The gums are lubricated with a solution, the composition of which is: 1 g of crystalline iodine, 2 g of potassium iodine and 40 ml of distilled water. Healthy gums turn yellowish. With chronic inflammation - brown. Depending on the degree of inflammation, the color of the gum varies from light brown to dark brown. For objectivity, the test can be quantified: evaluate the color of the papillae - 2 points, the color of the gingival margin - 4 points, the color of the alveolar gum - 8 points. The resulting score must be divided by the number of teeth in the area of ​​which the study is carried out (usually 6 teeth). Estimation of values: up to 2.3 points - mild inflammation, from 2.677 to 5 points - moderate inflammation, from 5.33 to 8 points - intense inflammation.

This method allows you to identify the symptoms of chronic inflammation of the gums. The test does not require any preparation.

Side effects after this type of diagnosis were not observed.

IR diaphanoscopy

All of the above types of diagnostics either cannot detect soft tissue inflammation or inflammation passed the stage of primary damage.

Therefore, the next type of diagnosis can determine the inflammation of periodontal tissues at an early stage - infrared diaphanoscopy.

Diaphanoscopy - transillumination with a narrow beam of light of percutaneous formations.

This diagnostic method is carried out in a darkened room with a special light source (in this case, a laser diode, since infrared radiation is required). The device is introduced into the patient's oral cavity, the radiation passes through the soft tissues of the periodontium. Healthy tissue will scatter radiation and have a reddish color. The inflamed areas will not be able to shine through, but will only absorb radiation, respectively, during the diagnosis, the doctor will see dark areas in the affected area. Since the device is located in the oral cavity, its dimensions must be small, the device must be waterproof and resistant to a temperature of 37 ± 0.5 ° C.

Rice. 19.

BOv - bioobject doctor

BOp - patient bioobject

The last diagram shows the interaction of the doctor, patient and diaphanoscope. Before starting the procedure, the doctor starts the source of infrared radiation, which emits a beam of light (radiation). The beam then passes through an optical system that includes lenses, diaphragms and a mirror to create a narrow directional beam of light. Biomedical glass is in contact with the oral cavity. The entire structure is waterproof. The doctor introduces a diaphanoscope into the oral cavity so that the radiation passes through the tissues, shines through (without heating) the necessary part of the oral cavity, and can see uneven illumination. Areas that absorb radiation are formed by denser tissues. Which allows us to make an assumption about the presence of an early stage of inflammation. This is what makes it possible to assume the presence of diseases. This is the most common way to assess periodontal disease.

Possible periodontal diseases are described in detail above.

Let's try to summarize everything in a table.

Tab. 3. - Correlation of types of diagnostics with possible conclusions.

Table 3 shows the possibilities of detecting oral and periodontal diseases using auxiliary methods of soft tissue diagnostics. Data on the harmful effects of each method are also given. And specifications.

Tab. 4. - Comparison of types of diagnostics.

Table 4 shows what information the doctor receives from each method and specific stage of the examination. Auxiliary methods include only those considered above, which are used to diagnose only the soft tissues of the periodontium.

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.

Index system for assessing the state of periodontal tissues.

To determine the state of periodontal tissues, a number of indices are used, which are subdivided as follows.

Papillary-marginal-alveolar index (PMA) - proposed by Masser (1948) and modified by Parma (1960).

The index is proposed to assess the inflammatory process in the gums.

The gums are stained in all teeth with Schiller-Pisarev solution (intravital staining of glycogen) and its condition is determined according to a 4-point system:

0 points - no inflammation;

1 point - inflammation of the papilla of the gums (P);

2 points - inflammation of the marginal gingival margin (M);

3 points - inflammation of the alveolar gums (A).

The PMA index is calculated by the formula:

In the Parma modification, the index is calculated as a percentage:

where 3 is the maximum index value for each tooth.

The sum of points is determined by summing up all indicators of the state of periodontal tissues near each individual tooth. The number of teeth in patients aged 6-11 years is 24, in 12-14 - 28, in 15 years and older - 30. In the period of temporary bite, that is, a child under 6 years old, has 20 teeth.

To assess the condition of periodontal tissues, the following criteria are accepted:

up to 25% - mild degree of gingivitis;

25-50% - the average degree of gingivitis;

more than 50% - severe degree of gingivitis.

Gingivitis Index GI (GI) proposed by Lowe and Silness (1967).

Characterizes the severity (intensity) of the inflammatory process in the gums.

The study is carried out visually. Determine the condition of the gums in the area of ​​16, 11, 24, 36, 31, 44th teeth according to a 4-point system:

0 points - no inflammation;

1 point - mild gingivitis (slight hyperemia);

2 points - average gingivitis (hyperemia, edema, hypertrophy is possible);

3 points - severe gingivitis (severe hyperemia, swelling, bleeding, ulceration).

Evaluation criteria:

0.1-1.0 - mild degree of gingivitis;

1,l-2.0 - average degree of gingivitis;

2.1-3.0 - severe degree of gingivitis.

Periodontal index PI (PI) proposed by Russell (1956), put into practice by Davis (1971); for practice, WHO recommends using the Russell index with the addition of Davis to study the severity of inflammatory-destructive changes in the periodontium.

The periodontal condition of each tooth is assessed (the presence of gingivitis, tooth mobility, the depth of periodontal pockets) according to the following evaluation criteria:

0-no inflammation;

1-mild gingivitis, inflammation does not cover the entire gum around the tooth;

2-inflammation surrounds the entire tooth, without damage to the attachment of the epithelium, there is no periodontal pocket;

4 - the same as with a score of 2 points, however, bone resorption is noted on the radiograph;

6-gingivitis and pathological periodontal pocket, immobile tooth;

8-destruction of periodontal tissues, the presence of a periodontal pocket, tooth mobility.

Formula for calculating the index:

Evaluation of results:

0.1-1.4 - mild degree of periodontitis;

1.5-4.4 - the average degree of periodontitis;

4.5-8.0 - severe degree of periodontitis.

Complex periodontal index KPI. Developed in MMSI in 1987.

Method of determination: visually, using the usual set of dental instruments, the presence of tartar, bleeding gums, subgingival tartar, periodontal pockets, pathological tooth mobility are determined and, if there is a sign, regardless of its severity (quantity), they are recorded in digital terms for each examined tooth. If there are several signs, the one that has a larger digital expression is registered.

Criteria for evaluation:

0 - pathological deviations are not determined;

1 - plaque;

2 - bleeding;

3 - tartar;

4 - periodontal pocket;

5 - tooth mobility.

Depending on age, the following teeth are examined:

at the age of 3-4 years: 55, 51, 65, 71, 75, 85th;

at the age of 7-14 years: 16.11, 26, 31, 36, 46th.

Individual KPI and average KPI are determined by the formulas:

Criteria for evaluation:

0.1-1.0 - risk of disease;

1.1-2.0 - mild degree of the disease;

2.1-3.5-average degree of the disease;

3.6-6.0 - severe degree of the disease.

Communal periodontal index (CPI). To determine this index, three indicators of periodontal status are used: the presence of bleeding gums, tartar and periodontal pockets.

A specially designed lightweight CPI (periodontal) probe with a ball at the end, with a diameter of 0.5 mm, is used. The probe has a black mark between 3.5mm and 5.5mm and a black ring at 8.5mm and 11.5mm from the tip of the probe.

To determine the index, the oral cavity is divided into sextants, including the following groups of teeth: 17-14, 13-23, 24-27, 37-34, 33-43, 44-47. In adults (20 years and older), 10 of the following so-called index teeth are examined: 17, 16.11, 26, 27, 37, 36, 31,46,47.

In patients younger than 20 years, only 6 index teeth are assessed - 16, 11, 26, 36, 31 and 46, in order to avoid inaccuracies associated with misdiagnosis of periodontal pockets during eruption of permanent teeth. When examining children under 15 years of age, measurements of the depth of periodontal pockets, as a rule, are not carried out, and only bleeding and tartar are recorded.

Identification of periodontal pockets and tartar is carried out using a periodontal probe. When probing in the area of ​​the index tooth, the probe is used as a "sensitive" tool to determine the depth of the pocket and detect subgingival calculus and bleeding. The force used in probing should not exceed 20g. A practical test for establishing this force is to place the probe under the thumbnail and press until discomfort is felt. Identification of subgingival tartar is carried out with the most minimal effort, allowing the probe ball to move along the surface of the tooth. If the patient experiences pain during probing, this indicates the use of excessive force.

For probing, the probe ball must be carefully placed in the gingival sulcus or pocket and probed throughout.

Criteria for evaluation:

0 - no signs of damage;

1 - bleeding, spontaneous or after probing, visible in the dental mirror;

2 - stone detected during probing, but all black

section of the probe is visible;

3 - pocket 4-5mm (periodontal pocket in the area of ​​the black mark of the probe);

4 - pocket 6mm or more (the black part of the probe is not visible);

X - excluded sextant (if there are less than 2 teeth in the sextant);

9 - not registered.

Methodology for determining the CPI index

Tests α=2

1. When examining a 12-year-old child with chronic colitis, it was found that the PMA index is 28%. What degree of gingivitis is determined in a child?

A. very light

C. medium

D. heavy

E. very heavy

2. When examining a 12-year-old child with chronic colitis, it was found that the PMA index is 20%. What degree of gingivitis is determined in a child?

A. very light

C. medium

D. heavy

E. very heavy

3. When examining a 12-year-old child with chronic colitis, it was found that the PMA index is 56%. What degree of gingivitis is determined in a child?

A. very light

C. medium

D. heavy

E. very heavy

4. When calculating the PMA index, the gum is stained:

A. methylene blue

B. Schiller-Pisarev solution

C. iodinol

D. erythrosin

E. magenta

5. 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

6. What index is used to assess the severity of gingivitis?

E. Green-Vermillion

A. periodontal disease

B. gingivitis

C. periodontitis

D. caries

E. periodontitis

8. The presence, localization and prevalence of the inflammatory process in the gums is determined using a test:

A. Silnes Low

B. Green-Vermilion

C. Shika-Asha

D. Kulazhenko

E. Schiller-Pisarev

9. What substance in the gum changes the color of the diagnostic reagent when determining the PMA index?

B. Proteins

C. Hemoglobin

D. Glycogen

E. Enzymes

10. How many points does the staining of the gingival papilla correspond to when determining the PMA index?

D. 0 points

11. How many points does the staining of the marginal gingival margin correspond to when determining the PMA index?

D. 0 points

12. What number of points corresponds to the staining of the alveolar gingiva when determining the PMA index?

D. 0 points

13. What number of points in determining the hygiene index corresponds to a slight hyperemia of the gums?

14. What number of points in determining the hygiene index corresponds to hyperemia, edema, possible gingival hypertrophy?

15. What number of points in determining the hygiene index corresponds to severe hyperemia, swelling, bleeding, ulceration of the gums?

Control questions (α=2).

1. Basic periodontal indices.

2. Schiller-Pisarev test.

3. Papillary-marginal-alveolar index (PMA), assessment criteria, interpretation of results.

5. Periodontal index (PI), evaluation criteria, interpretation of results.

6. Comprehensive periodontal index (CPI), evaluation criteria, interpretation of results.

7. Communal periodontal index ( CPI), assessment criteria, interpretation of results.

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

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

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

It is widely used to study the hygienic state of the oral cavity. Fedorov-Volodkina index. The 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. Using the hygienic index Silness-Loe evaluate:

A. Plaque area

B. plaque thickness

C. microbial composition of plaque

D. amount of plaque

E. plaque density

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

B. Green-Vermillion

D. Fedorova-Volodkina

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

B. Green-Vermillion

D. Fedorova-Volodkina

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

A. Lugol's solution

B. magenta solution

C. rr Schiller-Pisarev

D. solution of methylene blue

E. solution of trioxazine

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

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

match the values:

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

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

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

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

A. vestibular surface of the anterior group of teeth 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.

blister test used to determine the hydrophilicity of tissues and the latent edematous state of the oral mucosa. The technique is based on differences in the rate of resorption of an isotonic sodium chloride solution introduced into the tissue. The solution (0.2 ml) is injected with a thin needle under the epithelium of the mucous membrane of the lower lip, cheek or gum until a transparent vesicle is formed, which normally resolves after 50-60 minutes. Accelerated resorption (less than 25 minutes) indicates an increased hydrophilicity of tissues. Resorption of the bubble in more than 1 hour indicates reduced hydrophilicity. To obtain more reliable data, it is necessary to put 2-4 samples in parallel.

blister test used to determine sensitivity to histamine involved in allergic reactions. The technique is based on the fact that the size of the histamine papule directly depends on the content of histamine in the blood. On the cleansed and fat-free skin of the forearm, 1 drop of histamine is applied at a dilution of 1: 1000. Then, with a thin injection needle, the skin is pierced through a drop to a depth of 4 mm, and after 10 minutes, the diameter of the formed papule is measured. Normally, it is 5 mm, the diameter of the zone of redness (erythema) is 20 mm. The results of the test make it possible to judge the permeability of capillaries, the function of the autonomic nervous system, and the allergic state of the body. Histamine test (increase in the size of histamine papule) is positive in diseases of the gastrointestinal tract, recurrent aphthous stomatitis, multiform exudative erythema.

Schiller-Pisarev test used to determine the intensity of gingival inflammation. The gums are lubricated with a solution that contains 1 g of crystalline iodine, 2 g of potassium iodide and 40 ml of distilled water. Healthy gums turn straw-yellow. Chronic inflammation in the gums is accompanied by a significant increase in the amount of glycogen, stained brown with iodine. Depending on the severity of the inflammatory process, the color of the gums changes from light brown to dark brown.

Yasinovsky's test carried out to assess the emigration of leukocytes through the mucous membrane of the mouth and the amount of desquamated epithelium. The patient rinses his mouth with 50 ml of isotonic sodium chloride solution for 5 minutes. After a 5-minute break, he is asked to rinse his mouth with 15 ml of the same solution and the wash is collected in a test tube.

Mix 1 drop of wash and 1 drop of 1% solution of sodium eosin in isotonic sodium chloride solution on a glass slide and cover with glass. In a light microscope with an objective magnification of 20, the number of stained (pink) and unstained (greenish) leukocytes is counted (as a percentage). Cells with a preserved membrane (live) do not pass the dye, so they remain unstained. The number of such cells is an indicator of the viability of leukocytes.

1 drop of wash is placed in Goryaev's chamber and using a lens (x40) the number of leukocytes and epithelial cells is counted separately throughout the chamber. The volume of the Goryaev chamber is 0.9 µl, so to calculate the number of cells in 1 µl, the resulting number must be divided by 0.9.

In healthy people with intact periodontium and oral mucosa, the number of leukocytes in the flushing fluid ranges from 80 to 120 per 1 μl, of which 90 to 98% are viable cells, and 25-100 epithelial cells.

Kavetsky test with trypan blue in the modification of Bazarnova serves to determine the phagocytic activity and regenerative ability of the tissue. 0.1 ml of a 0.25% sterile solution of trypan or methylene blue is injected into the mucous membrane of the lower lip and the diameter of the formed spot is measured. Re-measurement is carried out after 3 hours. The sample index is expressed as the ratio of the square of the radius of the spot after 3 hours to the square of the radius of the initial spot - R 1 2 /R 2 2 . Normally, this indicator ranges from 5 to 7: less than 5 indicates a decrease in reactivity, more than 7 indicates its increase.

Rotter's test and language test in the modification of Yakovets used to determine the saturation of the body with ascorbic acid. The Rotter test is performed intradermally on the inside of the forearm. Language test: on the dried mucous membrane of the back of the tongue with an injection needle with a diameter of 0.2 mm, 1 drop of a 0.06% Tillmans paint solution is applied. The disappearance of the colored spot in more than 16-20 seconds indicates a deficiency of ascorbic acid.

Determination of the resistance of gingival capillaries according to Kulazhenko is based on a change in the time of formation of a hematoma on the gums at constant parameters of the diameter of the vacuum tip and negative pressure. Hematomas on the mucous membrane in the frontal section of the alveolar process of the upper jaw normally occur in 50-60 seconds, in other sections - for a longer time. In periodontal diseases, the time of hematoma formation is reduced by 2-5 times or more.

gum fluid(J) is determined by weighing filter paper strips on a torsion balance after they have been in a gum or periodontal pocket for 3 minutes. JJ is taken from 6 teeth (16, 21, 24, 31, 36, 44) and the gingival fluid index (GLI) is calculated using the formula:

Normally, the mass of filter paper impregnated with JJ is 0-0.1 mg, with chronic catarrhal gingivitis - 0.1-0.3 mg, with periodontitis - 0.3 mg or more.

17661 0

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

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

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

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

RMA index (Schur, Massler, 1948)

Schiller-Pisarev test

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

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

Gingival GI index (Loe, Silness, 1963)

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

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

Communal Periodontal Index CPI (1995)

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

Fig.6.12. Periodontal bellied probe.

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

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

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

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

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

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

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

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

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

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

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

T.V. Popruzhenko, T.N. Terekhova