Schiller Pisarev's solution in dentistry. functional tests. The pathogenesis of the action of local factors

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.

Periodontitis refers to inflammatory diseases of the oral cavity, in which changes occur in the state of periodontal tissues. The disease can bring a lot of inconvenience to the patient, especially in severe stages, when only supportive treatment is possible.

Therefore, timely diagnosis and differentiation from other diseases that are similar in the clinic, at the very beginning of its development, are very important.

Collection of anamnesis

The first thing a dentist does when he sees a patient is to take a history. The doctor specifies the following information:

• the presence of common somatic pathologies, for example, diabetes mellitus, hypertension, bronchial asthma;
• earlier manifestations of the disease and their frequency;
• recent manifestations;
• how is the daily;
• completeness of the diet;
• profession;
• patient complaints.

Determining the severity of the disease in the clinic

After collecting an anamnesis, a thorough examination of the entire oral cavity begins. Each of the stages will have its own manifestations:

1. Mild illness. In this case, the patient has a feeling of discomfort in the oral cavity. Appears during daily brushing of teeth, when eating solid foods. The gingival margin and papillae between the teeth appear cyanotic. The main symptom is the presence of a pathological pocket having a depth of up to 4 mm. The teeth are still immobile.
2. Disease with moderate severity. With moderate periodontitis, bleeding of the gingival margin will be somewhat greater. Appears permanent, and the teeth in a horizontal direction. The gums are swollen and hyperemic. When probing, periodontal pockets are determined, having a depth of 5 mm.
3. severe stage. This degree of severity is characterized by a violation of chewing and closing of teeth, which are mobile in all directions. There will also be signs of inflammation of the gingival margin. Pathological pockets have a depth of more than 5 mm. Quite often, purulent discharge can be found in them.

In all cases will be present.

This study is based on the staining of glycogen, which is deposited during inflammatory processes in the periodontal area, with an iodine solution. Depending on the intensity of staining, the degree of changes that have occurred is determined.

The brighter it is, the more pronounced the inflammation. The following gradation is used for evaluation:

• straw yellow color - no inflammation;
• light brown color - weak inflammation;
• dark brown color - severe inflammation.

The Schiller-Pisarev test is not specific. With its help, you can determine the dynamics of the treatment.

This index allows you to take into account all the signs of periodontal pathology.

Gradation of grades:

• 0 - complete absence of any changes;
• 1 - easy flow;
• 2 - inflammatory changes in the gums without a periodontal pocket;
• 6 - the appearance of a periodontal pocket, accompanied by a violation of the functioning of the periodontium, the tooth does not move;
• 8 - the deterioration of the condition of periodontal tissues is significantly pronounced, the tooth begins to move from its place.

The state of the tissues around each individual tooth is assessed. The calculation of the index is carried out according to the formula: PI = the sum of all grades / total number of teeth.

Interpretation of the results obtained:

• 0.1–1 – initial tissue damage;
• 1.4–4 - medium severity;
• 4-4.8 - severe course of the disease.

Test according to Kulazhenko

Used to determine the resistance of capillaries to vacuum. In the process of research, the Kulazhenko apparatus is used. It leads to the formation of a hematoma on the gum, according to the time of occurrence of which the degree of damage to the vascular wall is revealed.

Normal values:

• front teeth - 50-70 s;
• premolars - 70-90 s;
• lower molars - 80-100 s;
• upper molars - 80-90 s.

Hematoma formation in periodontitis occurs 8-9 times faster.

Instrumental and other research methods

Orthopantomography is one of the most informative studies in periodontitis. X-ray examination allows the most accurate assessment of the degree of changes in bone tissue and clarify the diagnosis.

With a mild degree of periodontitis, resorption of the interdental septa is 1/3. The average degree is associated with a decrease in the amount of bone to ½. With a severe course of the disease, the bone is already missing by 2/3.

Measuring the depth of pathological pockets also allows you to determine the degree of tissue damage. To do this, use a bellied graduated probe, and contrast solutions.

A biopsy of the gum tissue will be informative. As a result, an accurate diagnosis will be obtained, which will confirm the changes corresponding to rheumatic, hereditary and autoimmune diseases.

For greater effectiveness of treatment, microbiological and cytological examination of the contents of periodontal pockets is carried out. In the same way, the degree of changes that have occurred in periodontal tissues is determined.

The study of the composition of the gum fluid will give an idea of ​​the severity of inflammation. A large number of immune cells indicates a far advanced process.

Differential Diagnosis

Differential diagnosis of periodontitis is necessary with the following diseases:

1. . In this case, a common symptom will be inflammation of the gingival margin. Differences will be visible on the x-ray. With gingivitis, there is no loss of bone tissue and the development of periodontal pockets will not occur.
2. When there are no pathological pockets and signs of inflammation. There is only bone loss.
3. Premature bone atrophy. In this case, the changes will be in young people. There is no inflammation of the periodontal tissues, and the reduction of bone tissue occurs evenly.

Diagnosis is easy enough. To do this, you need to carefully collect anamnesis and conduct a complete examination of the patient.

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

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Page 5

METHODOLOGICAL DEVELOPMENT

practical exercises No. 6 7

by section

IV semester).

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

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

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

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

Lesson duration: 3 hours (117 min).

Lesson Plan

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

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

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

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

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

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

Potassium iodide 2.0

Crystalline iodine 1.0

Distilled water up to 40.0

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

Assessment of periodontal condition

Control questions to identify the initial knowledge of students:

Diagram of the indicative basis of action

determining the clinical condition of the gums.

Situational tasks

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

List of literature for preparation for classes in the section

"Prevention and epidemiology of dental diseases"

Department of Pediatric Dentistry, OmGMA ( IV semester).

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

Preventive section.

A. BASIC.

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

B. ADDITIONAL.

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

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

Since 2005

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

e-tutorials

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

Methodological developments for practical training of 2nd year students.

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

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

Structure of the Dental Association of the Federal District.

Educational standard for postgraduate professional training of specialists.

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

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

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

Video films

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

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

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

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

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

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

Oral hygiene index

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

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

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

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

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

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

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

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

The calculation is made according to the formula:

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

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

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

The quality of oral hygiene is assessed as follows:

good IG - 1.1 - 1.5 points;

satisfactory IG - 1, 6 - 2.0 points;

unsatisfactory IG - 2.1 - 2.5 points;

poor IG - 2.6 - 3.4 points;

very poor IG - 3.5 - 5.0 points.

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

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

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

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

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

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

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

lack of plaque - 0

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

OHI-s = Sum of indicators / 6

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

OHI-s > 1 - poor hygienic condition.

Papillary Marginal Alveolar Index (PMA)

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

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

inflammation of the papilla - 1 point;

inflammation of the gingival margin - 2 points;

inflammation of the alveolar gums - 3 points.

Assess the condition of the gums for each tooth.

The index is calculated using the following formula:

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

where 3 is the averaging coefficient.

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

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

Determination of the numerical value of the Schiller-Pisarev test

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

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

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

mild process of inflammation - up to 2.3 points;

moderately pronounced process of inflammation - 2.3-5.0 points;

intense inflammatory process - 5.1-8.0 points.

Schiller-Pisarev test

To characterize inflammation, the following gradation was adopted:

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

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

– staining in dark brown color – a positive test.

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

Periodontal index

The following ratings are used:

no changes and inflammation - 0;

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

from all sides) - 1;

gingivitis without damage to the attached epithelium (clinical

pocket is not defined) – 2;

gingivitis with the formation of a clinical pocket, dysfunction

no, the tooth is immobile - 6;

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

can be shifted - 8.

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

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

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

The index values ​​are as follows:

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

1.5–4.0 - moderate degree of periodontal pathology;

4.0–4.8 - severe degree of periodontal pathology.

Index of need in the treatment of periodontal diseases

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

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

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

The CPITN index is evaluated by the following codes:

- no signs of disease;

- gingival bleeding after probing;

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

– clinical pocket 4–5 mm deep;

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

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

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

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 monitoring 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