Method of treating initial caries involving preliminary assessment of reversible abnormal changes of enamel accompanying early cariosity

FIELD: medicine.

SUBSTANCE: method involves preliminary assessment of the reversible abnormal changes of enamel accompanying early cariosity. That is ensured by diagnostic tests of solid dental tissues conducted by using light-induced fluorescence and electrometric measurement techniques followed by therapy involving daily applications of the Radogel-GABA preparation. If observing visually detected changes with a current intensity of 0.21-1.99 mcA in the lesion and the presence of fluorescence, the preclinical changes of enamel are diagnosed requiring 5 therapeutic procedures with the above preparation. Visualised tarnishing of enamel accompanied by a current intensity of 2.00-3.99 mcA in the lesion and the presence of fluorescence, an early carious change of enamel at the stage of a dead spot is diagnosed, and 7 therapeutic procedures are conducted. If visualising a white spot of enamel accompanied by a current intensity of 4.00-5.99 mcA in the lesion and the presence of fluorescence, an early carious change of enamel at the stage of a white spot is diagnosed, and 10 therapeutic procedures are conducted. If visualising a white spot of enamel accompanied by a current intensity of 6.00-7.99 mcA in the lesion and the presence of fluorescence, an early carious change of enamel at the stage of an intense white spot is diagnosed, and 15 therapeutic procedures with the Radogel-GABA preparation are required.

EFFECT: method provides the high-effective therapeutic exposure on caries by the timely recovery of the protein dental matrix with simplicity and ease of use at massive dental visits.

2 tbl

 

The invention relates to medicine and can be used in practical health care in mass screening of patients for pre-clinical and early clinical diagnosis and treatment of initial caries using objective instrumental methods of examination and individualized treatment regimen.

It is known that early diagnosis of pathology of the hard tissues of the teeth can cut the development process at an early stage, which increases the quality of dental care [Sadovsky centuries the Use of high-tech methods in the diagnosis of diseases of the teeth / in. A. Sadowski, I. A. space through defence, B. R. the Shumilovich // Institute of dentistry. - 2008. No. 1. - S. 74-75. Modern methods of diagnostics and treatment of dental diseases / A. A. Kunin, L. I. lepekhina, C. A. Nekrasov, S. N. Pankov, I. A. Space Through Defence, B. R. The Shumilovich. - Voronezh, 2001. - 24 S. textbook stamped ULV].

Known methods luminous diagnosis of the early stages of dental caries using fiber optic light (FOL) in clinical karjalohja diagnostic purposes [Axelsson P. Diagnosis and risk prediction of dental caries/P. Axelsson // Quintessence Publishing. - 2000. - 307 p]. The study was conducted in a dark room with a light guide made of organic glass, attached to a dental mirror. The method of transillumination is, is that the tooth is illuminated with light and carious defects appear as dark spots. The effect is based on different porosity and the difference of the refractive index of light in healthy and diseased tissues.

However, transilluminated method does not allow to assess the surface condition of the affected area and set its depth. The presence of seals on the tooth significantly complicates diagnosis using this method.

Another diagnostic method for detection of caries based on light, a luminescent somatoscope [Kunin, A. A. dependence of the optical characteristics of hard tissues of a tooth from its morphological and chemical structure / Kunin, A. A., Moiseev, N. S., Kunin D. A. // journal of the Institute of dentistry (jubilee issue). Materials dental Congress on precautionary, preventive and personalized dentistry under the EPMA, dedicated to the 55th anniversary of the faculty of dentistry, ugma them. N. N. Burdenko, No. 3 (15), November, 2012], is based on the phenomenon of the effect of luminescence of hard tissue of teeth, arising under the influence of ultraviolet irradiation. The study was conducted in a darkened room, aiming at the dried tooth surface a beam of ultraviolet rays. The analyzed surface cover at a distance of 20-30 cm quartz lamp with a filter of dark purple glass. In the ultraviolet rays of healthy teeth flyuorestsiruyut snow-b is small shade and decayed areas and artificial teeth look darker with clear contours.

However, fluorescent somatoscope too time-consuming to conduct mass dental reception. In addition, its implementation is much more difficult, as it requires a special dental equipment. The disadvantages of the method also applies a low percentage of the reliability of the research.

Another diagnostic method is a method of diagnosis of caries, which is based on laser fluorescence [LussiA., Hibsi R., Paulus R. DIAGNOdent: an optical methods for caries detection //J. Dent. Res. - 2004. - Vol.83, Spec. Iss. C. - P. 80-83, Zaitseva E. C. Development of method for fluorescent diagnostics of hard tissues of the tooth with a carious lesion (experimental clinical research): Dis. Kida. the honey. Sciences. M - 2000. - S. 188, Morozova O. A. Experimental validation of the Express-method of laser fluorescent diagnostics of diseases of microbial nature: author. dis. Kida. the honey. Sciences. M - 2001. - C.-25]. The method consists in the irradiation of the tooth using a laser diode and a wavelength of 655 nm and the power light is less than or equal to 1 mW. Allows to detect the initial fissure caries and vestibular surfaces of the teeth, but the high cost of dental equipment and the complexity of the procedures for the preparation, consisting in cleaning the tooth before diag is asticheskoe manipulation, do not allow to implement it everywhere. The above methods are most effective when clinically detectable caries process, to clarify the extent defeat the purpose of monitoring the results of prevention and treatment. Data diagnostic methods do not take into account subtle reversible changes of enamel occurring on the pre-clinical stage development of the caries process.

With regard to the methods of caries prevention, known methods remineralizing effects of drugs on the basis of calcium and fluoride on the hearth affected the enamel surface, such as a 10% solution of calcium gluconate 2% solution of sodium fluoride. However, treatment-and-prophylactic therapy of the initial decay time-consuming, as it requires at least 30 applications preventive medication every day and not always effective, because it is proved by the lack of positive effects of fluoride on the enamel of the teeth of patients aged 18 years and older [Cahen et al. //Community Dent Oral Epidemiol, 1982, 10: 238-241, Kunin, A. A. et al.//Clinical dentistry, №4(36) 2005: 60-63].

Another preventive method over the initial decay is the use of drugs of amino silver ("Saforide" company "Too Seiyaku, Argent one-component" company "Vladiv"), combining the antimicrobial effect of silver ions with the effects of fluoridation and seal the enamel. Report, is that a 3-5 daily applications of amino silver twice a year allows you to achieve a 54% reduction of caries. Negative effects of drugs of silver is considered sustainable change in color of the treated tissue of the tooth to black [Popruzhenko T. C. Prevention of dental caries with the use of products containing fluoride, calcium and phosphate: textbook.-method. manual /So Century. Popruzhenko, M. I. Klenovsky. - Minsk: bgmu, 2010. - S. 42-43].

The technical result - the development of ways to improve the efficiency of diagnosis and primary prevention of dental caries with high precision grade, reversible changes of enamel on the pre-clinical stage development of the caries process. The method is distinguished by the simplicity of performing diagnostic procedures, usability techniques for mass dental reception due to the combined use of two diagnostic methods - svetoindutsirovannoi fluorescence and conductivity, as well as highly effective therapeutic and preventive therapy aimed at restoring the protein matrix of the tooth.

The proposed method for early diagnosis and prevention of dental caries is as follows.

To assess the fluorescence of hard tissue surface visually intact teeth are dried by a stream of air. Then, in the mode of emission of green color at a wavelength of not less than 530 nm, illumination not less than 10 000 Lux, with the density of the radiation power of 140 mW/cm 2with the help of a light guide apparatus Shine all surfaces of the teeth and register areas of the tooth surface with a brighter glow. For research use, for example, led activator "LED asset LLC MEDTAG+", Russia.

In addition to fluorescence for research use electrometric apparatus, for example, "Dentist" CJSC "Geosites, Russia. For measuring conductivity of the enamel surfaces of the teeth: the vestibular surface, cutting edge, chipped enamel, cervical region, intact another border with seal - thoroughly dried by turondale and air jet. Sensitivity set on the instrument panel not less than 1:100. Passive electrode, which is dental mirror, placed in the mouth, ensuring good contact with the soft tissues of the oral cavity. In microspec, displacement, for example, 2 ml, which acts as the active electrode, trying to enter the electrolyte solution consisting of a 0.9% physiological solution of sodium chloride and glycerine in equal proportions 1:1, so that at the end of the needle formed a meniscus of the electrolyte. The active electrode is set to a thoroughly dried investigated area of the tooth, the readings recorded. The measurements were carried out at constant voltage of at least 4.26 deaths Volts, and the results of measurements per is read in microampere.

According to the manufacturer's instructions for the size range of indicators electrodiagnostic apparatus "DENTIST" the following: 0 to 0.2 µa - intact mineralized enamel; 3.9 to 7.9 MCA - initial caries; 8,0-27,7 MCA - surface caries; 27,8-50 µa average caries; more 50,0 MCA - deep caries.

The manufacturer's instructions does not interpret the gradation state of the enamel in the range of the current strength of 0.2-3.9 μa, which prompted us to develop our own classification. In the process of the research work declared by the manufacturer in the range 0-0,2 µa fluorescent glow, we did not observe. When 0,21-3,99 MCA degree luminosity was increased in direct proportion to the value of the current intensity in the lesion, which allowed us to develop our own data table, which evaluates the presence of luminescence (see tab.1).

Table 1.

The ratio of state to tooth enamel and measurement readings of current and fluorescence

The condition of the enamelThe average value of the current strength in the lesion (µa)Light-induced fluorescence (530 nm) strengthening glow
Intact enamel0-0,2no
Preclinical changes EMA and 0,21 - 1,99
Initial changes enamel
matte stain2,00 - 3,99
white spot4,00 of 5.99
intense white spot6,00-7,99

From table 1 it is seen that the fluorescence of damaged tissues is only when damage to the enamel, healthy tooth tissue fluorescence is absent.

Healthy enamel - insulator, increasing the digital readout electrometric device indicates the presence of caries process.

Patients with diagnosed using diagnostic instruments initial carious process - pre-clinical, frosted, white or bright white carious changes enamel is directed at treatment and preventive therapy drug "Radael-GABA containing essential amino acids and hyaluronic acid.

Remineraliziruyuschy gel Radael-GABA" domestic developments, water-based contains a range of essential amino acids: lysine 0.3%, arginine 1,2%, histidine 0,1%, the optimal ratio which gives the content of inorganic fillers component of tooth properties of the osmotic membrane, a natural fabric barrier for microorganisms.

The presence of ions of calcium together with vitamin D contributes to the formation of the mineral component of the tooth, strengthening the enamel. Formulated with vitamin B12 activates the processes of mineral metabolism in the enamel. Hyaluronic acid (0,5%), together with the amino acid contributes to the formation of a tissue barrier besprizornyh spaces enamel.

The prevention of dental caries was carried out according to the following procedure: teeth with a focal demineralization identified methods and Electrometry svetoindutsirovannoi fluorescence, isolated from saliva. The surface of the affected teeth mechanically cleaned of soft plaque, were treated with an antiseptic solution, such as 5% solution of hydrogen peroxide or 3% sodium hypochlorite solution, and dried by a stream of air. On the prepared surface of the affected enamel inflicted drug "Radael-GABA" according to the manufacturer's instructions and left on the tooth surface for 25-30 minutes. The remnants of the gel was removed with a cotton swab. The course of treatment was for preclinical changes enamel, amperage of 0.21 - 1.99 MCA and the presence of fluorescence - 5 procedures for carious changes on stage matte stains, amperage 2,00 - 3,99 MCA and the presence of fluorescence - 7 procedures; for carious changes at the stage of white spots, the power toka,00 - 5,99 MCA and the presence of fluorescence - 10 procedures; for carious changes at the stage of intense white spots, amperage 6,00 - 7,99 MCA and the presence of fluorescence - 15 appliqués, held every day.

In the Center of individual prevention-based dental clinic Voronezh state medical Academy named. N. N. Burdenko conducted a comprehensive clinical dental examination 50 patients. According to a survey of somatic pathology in the acute stage of the surveyed were not. Identified pre-clinical and early clinical carious changes enamel using svetoindutsirovannoi fluorescence and Electrometry, then surveyed the patients were divided into two groups. The first group included 20 patients, prophylaxis was performed according to the proposed scheme, select the number of treatments using therapeutic and prophylactic drug therapy "Radael-GABA". In the second group, consisting of 30 people, medical therapy was performed according to the standard scheme with a 2% solution of sodium fluoride (see tab.2).

Table 2

The dynamics of the patient depending on patterns of use of preventive and curative drug

The condition of the enamelTo the l-in procedures is Electrometry in the lesion (µa)Patients ' complaints
before therapyafter therapy
The proposed method
Preclinical changes enamel51,20no
Early clinical changes enamelmatte stain72,50no
white spot104,50,09no
intense white spot156,50,1no
The known method
Preclinical changes enamel-- --
Early clinical changes enamelmatte stain152,50unpleasant taste, increased salivation after 7-8 procedures
white spot154,50,09unpleasant taste, increased salivation after 7-8 procedures
intense white spot156,50,1unpleasant taste, increased salivation after 7-8 procedures

Table 2 shows that as a result of preventive and curative treatment of the proposed method achieved a marked positive therapeutic effect, clinically proven results of the diagnostic methods - svetoindutsirovannoi fluorescence and electromedical diagnostics. A detailed study found that patients treated in a known manner, on the stages of the treatment complained of unpleasant is sushenya in the mouth, increased salivation during the procedure and dryness in the mouth after 3-4 hours after its execution. In the study group, which used a differentiated scheme dosed treatment-and-prophylactic drug, complaints were absent.

Thus, the use of the proposed differential scheme for the diagnosis and treatment of initial caries in contrast to the known increases the effectiveness of early diagnosis of caries detection of preclinical forms of caries process, thereby eliminating low-quality diagnostics and contributing to the early prevention of dental caries.

The method of treatment of initial caries, including preliminary assessment of reversible changes of enamel in the initial stages of the carious process, characterized in that conduct diagnostic testing of hard tissues of teeth using svetoindutsirovannoi fluorescence and Electrometry, and subsequent therapy by daily applications of the drug "Radael-GABA", and in the absence of visually detectable changes amperage in the lesion of 0.21-1.99 MCA and the presence of a fluorescent glow diagnose preclinical changes in enamel and spend 5 therapy procedures specified medication; when visually detectable loss of gloss enamel, amperage in the lesion 2,00-3,99 MCA and the presence of fluore the interest of the glow diagnosed early initial carious changes enamel - stage matte spots and spend 7 therapy procedures; when visually defined white spot enamel amperage in the lesion of 4.00 to 5.99 × µa and the presence of a fluorescent glow diagnosed early initial carious change of enamel white spot and spend 10 sessions of therapy; when visually defined white spot enamel amperage in the lesion 6,00-7,99 MCA and the presence of a fluorescent glow diagnosed early initial carious changes enamel - bright white spot and spend 15 procedures of drug therapy "Radael-GABA".



 

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