The textbook was compiled by employees of the Department of Dentistry of the Faculty of Pedagogical Education and Teaching Staff of the Dagmedacademy. What is the Schiller test in gynecology? Indications for the Schiller test
Its principle is to stain the gum glycogen with Schiller-Pisarev solution (reaction with iodine). During inflammation, glycogen accumulates in the gums due to keratinization of the epithelium. Therefore, when interacting with iodine, inflamed gums are stained more intensely than healthy ones. It takes on shades from light brown to dark brown. More intense coloring indicates a greater degree of inflammation.
The Schiller-Pisarev test is carried out as follows: dry the examined area of the gum with a cotton swab, isolate it from saliva and lubricate it with a cotton ball soaked in Lugol's solution or Schiller-Pisarev solution. The Schiller-Pisarev test is used in children to detect gingivitis. To do this, the gums are stained with the following solution: potassium iodide – 2.0 crystalline iodine – 1.0 distilled water – up to 40.0. Healthy gums are not stained by this solution. A change in its color under the influence of this solution occurs during inflammation, and then the test is considered positive.
PMA Index- Papillary – Marginal – Alveolar index.
To assess the severity of gingivitis and record the dynamics of inflammatory processes in the gums, the PMA index is used. The condition of the gums of each tooth is assessed visually after staining it with Schiller-Pisarev solution. In this case, the inflamed areas of the gums acquire a brown color due to the presence of glycogen in them.
RMA Index Assessment carried out according to the following codes and criteria:
0 – no inflammation (the gums are not stained with Schiller-Pisarev solution)
1 – inflammation of only the gingival papilla (P)
2 – inflammation of the marginal gum (M)
3 – inflammation of the alveolar gum (A)
The PMA index is equal to the sum of the points of the examined teeth divided by the product of the number 3 by the number of examined teeth as a percentage.
The PMA index is calculated using the formula: PMA = (sum of points) / (3 * number of teeth examined) * 100%
The amount of tooth integrity, while maintaining the integrity of the dentition, is taken into account depending on age:
6 – 11 years – 24 teeth
12 – 14 years – 28 teeth
15 years and older – 30 teeth
If there are missing teeth, then divide by the number of teeth present in the oral cavity.
Ideally, the PMA index tends to zero. The higher the digital value of the index, the higher the intensity of gingivitis.
Evaluation criteria for the RMA index:
Ó 30% or less – mild severity of gingivitis
Ó 31 – 60% - moderate severity
Ó 61% and above – severe
999 06/18/2019 4 min.Periodontal diseases are widespread, so it is necessary to use advanced methods to make the most accurate diagnoses and differentiate one pathology from another. For this reason, various periodontal indices have been developed that make it possible to monitor 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. In this review we will talk about this method of research as the Schiller-Pisarev test, its advantages, disadvantages and features.
Determination of the diagnostic method - 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 over a certain time period, assessing the depth and extent of the pathological process, allowing one to compare the effectiveness of the therapeutic methods used, and processing the results mathematically.
There are several types of periodontal indices - 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 indicators, pocket depth, and tooth mobility. Irreversible characterizes the degree of bone tissue resorption and gum atrophy. Complex ones allow for a comprehensive assessment of the condition of periodontal tissues.
The Schiller-Pisarev test assumes intravital staining of gum glycogen - the content of this component increases significantly with. That is, intense staining of the gums indicates that it is inflamed. The test can also be used after completion of a course of treatment and to draw up a further course of action.
Advantages and disadvantages
An important component of implantation at all stages is an accurate index assessment of the condition 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 - this is periodontal destruction, the amount of tartar, plaques, the need for certain therapeutic measures and their volume.
The relationship between the elements of the implant and adjacent tissues, its difference from a natural tooth, can make complex periodontal studies impossible.
The Schiller-Pisarev test is quite accurate and objective and has two interpretation options. The first is visual, based on the nature of the gum staining, the second is numerical, that is, index. The main problem of the technique is that dental indices from 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 results to be most successfully adapted to the conditions of endosseous implantation. However, the convention 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 performed?
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 connective tissue lesions become stained - this is due to the accumulation of large volumes of glycogen in areas of inflammation. The tests 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 tests should be weakly positive or negative.
Gum staining is due to the high amount of glycogen. When the inflammation passes, there is less glycogen, and the tissues cease to be intensely stained. In this way, the intensity and degree of development of the disease is determined.
Composition of the solution
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 therapeutic and prophylactic toothpaste (, Parodontol), the gum mucosa is lubricated with a special solution, then the degree of staining is determined, the data obtained is recorded in the history of the disease. Control – after 1, 2, 3, 6 and 12 months.
Result: index calculation, assessment of gum condition
For objectification purposes, the Schiller-Pisarev test is expressed in numbers (scores). The color of the papillae is rated at 2 points, the gingival margins at 4, and the gingival alveoli at 8 points. The total amount obtained is then divided by the number of teeth in the study area. That is, the calculation formula looks like this:
Iodine number = Sum of assessments for each tooth / Number of teeth examined.
The result is an iodine number in points. Evaluation of results by points:
- mild inflammation – up to 2.3 points;
- moderate inflammation – 2.67-5.0 points;
- severe inflammation – 5.33-8.0 points.
The peripheral circulation index (abbreviated as IPC) is also 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 assessed in points, their ratio is expressed as a percentage. The index is calculated using the following formula:
- resistance of gum capillaries (scores);
- period of hematoma resorption (scores).
Based on index indicators, the functional state of the peripheral circulatory system is assessed. An IPC from 0.8 to 1.0 is considered normal, 0.6-0.7 is a good condition, 0.075-0.5 is a satisfactory condition, and from 0.01 to 0.074 is a decompensated state. You might be interested to know
DAGESTAN STATE MEDICAL ACADEMY
DEPARTMENT OF DENTISTRY, FACULTY OF ADVANCED QUALIFICATIONS OF DOCTORS AND PROFESSIONAL RETRAINING OF SPECIALISTS
___________________________________________________________
A.I. Abdurakhmanov, G.-M.G. Murtazaliev, G.G. Abdurakhmanov,
A.M. Nurmagomedov, M.M. Salikhova
METHODS OF ADDITIONAL EXAMINATION OF A PATIENT IN THE CLINIC OF THERAPEUTIC DENTISTRY
(Tutorial)
Makhachkala 2012
The textbook was compiled by employees of the Department of Dentistry of the Faculty of Pedagogical Education and the Teaching Staff of the Dagmed Academy:
A. I. Abdurakhmanov – head of the department.
G.-M. G. Murtazaliev – Associate Professor of the Department.
G.G. Abdurakhmanov – Assistant at the Department of Therapeutic Dentistry.
A. M. Nurmagomedov – Associate Professor of the Department.
M. M. Salikhova – Associate Professor of the Department.
The proposed educational material is designed for the final result and is based on a unified methodological basis. It is designed to help in processing the necessary information and manage extracurricular training on the topic being studied.
The manual is intended for interns and clinical residents, doctors in advanced training cycles.
The proposed educational manual presents questions of additional examination in dentistry without understanding, which are impossible to successfully diagnose and treat dental diseases. The main methods for conducting additional research, indications for their use in various areas of dental practice, and schemes for analyzing the results obtained are considered.
Reviewer:
K. M. Rasulov – Head of the Department of Orthopedic Dentistry, Professor, Doctor of Medical Sciences.
E.A. Kurbanova – Associate Professor of the Department of Therapeutic Dentistry.
^ ADDITIONAL INVESTIGATION METHODS
A PATIENT IN THE THERAPEUTIC CLINIC
DENTISTRY
Target: teach students how to navigate the processing of necessary information and help in theoretical preparation for the upcoming practical lesson on this topic.
The result of achieving this goal is knowledge:
Indications for auxiliary studies.
Methods necessary for examining a dental patient.
Exercise:
Study in detail additional methods of examining a patient in a therapeutic dentistry clinic.
Create situational problems on this topic.
Diagnosis of diseases of dental hard tissues.
Vital coloring.
Dentistry.
Determination of pH of oral fluid.
Determination of caries activity by type of oral lactobacilli. Lactobacillon test.
Determination of enamel resistance to acids.
Radiography.
Diagnosis of periodontal tissue diseases
Hygienic indices.
Index of need for periodontal treatment.
Radiography.
Functional tests.
Polarographic research.
Bacteriological research.
Biochemical research.
Visual research method
^ Vital tooth staining method
The surface of the teeth is thoroughly cleaned of plaque and dried. A loose cotton swab soaked in a 2% aqueous solution of methylene blue is applied to the prepared tooth surface for 3 minutes. (L.A. Aksamit, 1973). After removing the tampon and washing off the paint from the surface of the tooth with water using tampons or rinsing, the intensity of staining of the lesion is assessed. There are light, medium and highest degrees of color (depending on the degree of demineralization).
3. Dentistry in ultraviolet light is indicated for diagnosing the degree of activity and prevalence (in area) of demineralization with visible carious spots. It is performed in a darkened room using a fluorescent stomatoscope. First, the surface of the damaged tooth is cleaned of plaque. Healthy teeth in UV rays glow with a bluish color, while carious spots are characterized by a kind of quenching of luminescence with a clearer appearance of the contours of the lesion.
^ 4. Method for determining the pH of oral fluid
The pH of the oral fluid is measured using an electronic pH meter model 340. Oral fluid is collected on an empty stomach in the morning in an amount of 20 ml. The same sample is measured three times, after which the average value is determined. It is believed that a decrease in the pH of oral fluid is a prognostic symptom of active progressive dental caries.
^ 5. Method for determining saliva viscosity determined with an Oswald viscometer. Saliva is collected into test tubes with a capacity of 20-30 ml 2-3 hours after eating and examined in a device. At least 3 studies are performed on one patient and average numbers are obtained.
It is believed that in caries-resistant individuals the viscosity of saliva is 4.16 ± 0.22 units. In those susceptible to caries, saliva is more viscous - 9.58±0.48 units.
^ Determination of caries activity by the titer of oral lactobacilli
An increase in lactobacilli in the oral fluid indicates the active development of caries and can serve as a prognosis for the occurrence of carious cavities.
^ Method for determining the resistance of enamel to exposure
The principle is based on the ability to determine the amount of hydrochloric acid applied to the surface of the enamel using indicator paper with a diameter of 2 mm. dissolve tooth enamel and change the color of the indicator paper.
Methodology. The labial surface of the tooth being examined is cleaned with a mixture of pumice powder and chalk and dried, then a circle of indicator paper moistened with 1.5 microns of hydrochloric acid is placed on the surface of the tooth. The time that will pass from the moment the acid is applied until the color of the indicator changes from light green to purple is set using a stopwatch and is considered a “relative measure” for determining the resistance of enamel to acids. During the determination, artificial lighting is used (50 W operating lamp). The tooth being examined is the left or right incisor (for repeated examinations, the corresponding tooth on the other side of the jaw).
^ Determination of the papillary-marginal-alveolar index
The papillary-marginal-alveolar index (PMA) allows one to judge the extent and severity of gingivitis. The index can be expressed in absolute numbers or as a percentage.
The inflammatory process is assessed as follows:
inflammation of the papilla - 1 point;
inflammation of the gum edge - 2 points;
inflammation of the alveolar gum - 3 points.
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 - 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 index value with 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 (Svrakov iodine number). To determine the depth of the inflammatory process, L. Svrakov and Yu. Pisarev proposed lubricating the mucous membrane with an iodine-iodide-potassium solution. Staining occurs in areas of deep connective tissue damage. This is due to the accumulation of large amounts of glycogen in areas of inflammation. The test is quite sensitive and objective. When the inflammatory process subsides or stops, the intensity of the color and its area decrease.
When examining the patient, lubricate the gums with the specified solution. The degree of coloring is determined and recorded in the examination card. The intensity of gum darkening can be expressed in numbers (points): color of the gingival papillae - 2 points, color of the gingival margin - 4 points, color of the alveolar gum - 8 points. The total score is divided by the number of teeth in which the study was carried out (usually 6):
Iodine number = 
,
mild inflammation process - up to 2.3 points;
moderately expressed process of inflammation - 2.3-5.0 points;
intense inflammatory process - 5.1-8.0 points.
Schiller-Pisarev test. The Schiller-Pisarev test is based on the detection of glycogen in the gum, the content of which increases sharply during inflammation due to the lack of keratinization of the epithelium. In the epithelium of healthy gums, glycogen is either absent or there are traces of it. Depending on the intensity of inflammation, the color of the gums when lubricated with a modified Schiller-Pisarev solution changes from light brown to dark brown. With healthy periodontium, there is no difference in the color of the gums. The test can also serve as a criterion for the effectiveness of the treatment, since anti-inflammatory therapy reduces the amount of glycogen in the gums. To characterize inflammation, the following gradation has been adopted:
staining of the gums in a straw-yellow color - negative test;
staining of the mucous membrane in a light brown color - a weakly positive test;
dark brown coloring is a positive test.
In some cases, the test is used with the simultaneous use of a stomatoscope (20 times magnification). The Schiller-Pisarev test is performed for periodontal diseases before and after treatment; it is not specific, however, if it is impossible to use other tests, it can serve as a relative indicator of the dynamics of the inflammatory process during treatment.
^ Study of gingival fluid parameters
Gingival fluid is an environment of the body that has a complex composition: leukocytes, desquamated epithelial cells, microorganisms, electrolytes, proteins, enzymes and other substances.
There are several ways to determine the amount of gingival fluid. G.M. Barer et al. (1989) suggest doing this using strips of filter paper 5 mm wide and 15 mm long, which are inserted into the gingival sulcus for 3 minutes. The amount of adsorbed gingival fluid is measured by weighing the strips on a torsion balance or determining the zone of impregnation with a 0.2% alcohol solution of ninhydrin. However, this technique requires the subsequent use of special reagents and time, since ninhydrin colors the strip only after some time (sometimes after 1 - 1.5 hours) depending on the air temperature in the room.
L.M. Tsepov (1995) proposed making measuring strips from universal indicator paper, pre-colored blue with a solution with pH 1.0. Considering that the pH of the gingival fluid ranges from 6.30 to 7.93, regardless of the degree of inflammation, the area of paper soaked in the gingival fluid turns yellow. It has been established 1 that the hygroscopicity of filter and indicator paper is the same, i.e., the results of both methods are comparable. Painted strips can be stored for a long time without changing color at room temperature.
A template has been developed to determine the amount of gingival fluid. The dependence of the area of impregnation and the mass of gingival fluid adsorbed by a standard strip was experimentally derived [Barer G.M. et al., 1989]. There is evidence of the possibility of using gingival fluid parameters for diagnostic purposes, as well as for monitoring the effectiveness of therapeutic and preventive measures.
The clinic notes a significant positive correlation between the indices of inflammation, bleeding gums, hygiene and the amount of gingival fluid. At the same time, it should be remembered that determining the amount of gingival fluid is most informative during initial changes in the periodontium. With developed periodontitis, its quantity correlates with the depth of clinical pockets, which reduces the differential diagnostic value of the method, and the interest is mainly in studying the qualitative composition of the gingival fluid.
^ Microbiological examination of contents
periodontal pockets
In case of periodontal diseases, a microbiological study is carried out to establish the composition of the microflora of periodontal pockets, determine its sensitivity to antibiotics and other drugs to monitor the effectiveness of treatment.
For research, you can take pus and discharge from periodontal pockets, oral fluid, and material obtained during curettage of periodontal pockets.
The most convenient method is proposed by V.V. Khazanova et al. (1991). Before taking the material, the patient is asked to rinse his mouth, the tooth is washed with a sterile isotonic sodium chloride solution, covered with sterile rollers and dried. A sterile standard disc (diameter 6 mm) made of cellophane film (thickness 40 µm) is then inserted into the periodontal pocket using a button probe so that the disc is bent in half. The contents of the pocket fill the space
^ X-ray examination
The method is leading in everyday dental practice both for diagnosing diseases and for assessing the effectiveness of treatment measures. Dynamic radiographs allow timely identification of possible complications.
There are many radiological techniques: intraoral and extraoral photographs, tomograms, panoramic radiographs, radiovisiograms, computed tomograms.
The most widely used are intraoral (contact and bite) photographs; interproximal (according to Raper) and photographs with a long focal length are less known.
In outpatient settings, intraoral close-focus contact radiography is most often used.
X-rays are of great help to the doctor in the treatment of root canals of teeth (their direction, degree of filling, and patency are determined from the X-ray), determining the condition of the tissues surrounding the tooth root, identifying pathological processes in bone tissue and its structure.
The principle of the method is that, depending on the density of the tissues in the area under study, X-rays are blocked to a greater or lesser extent by them. If there are dense tissues in the path of the rays (for example, mineralized tissues: bone, teeth), then they absorb the rays and there will be a light area in the picture (negative). In places where absorption is less, the rays affect the film and a dark image is formed in the picture. Image quality largely depends on the direction of the rays. To obtain the most accurate image - to avoid lengthening or shortening of the tooth - it is desirable that it is in focus, and the central beam of rays is directed perpendicular to the object and the film.
An x-ray helps to determine the condition of the tissue only if it is performed in accordance with the basic requirements. The image must have sufficient contrast, which allows you to distinguish one tissue from another (with their different densities); adjacent areas should not overlap the tissue or organ being examined; The size of the image should correspond as much as possible to the actual size of the object being examined - the tooth root. Performing intraoral contact radiographs requires compliance with certain rules: bisector and tangent. Violation of them leads to gross distortions (elongated or shortened teeth, projection layering of adjacent teeth).
When obtaining contact radiographs of the upper incisors, it is advisable to use a larger angulation, given that periapical changes are often located behind the root apices.
To obtain separate images of the buccal and palatal roots, it is necessary to take an image in an oblique projection.
It is possible to avoid overlap of the zygomatic bone on the roots of the second and third molars by directing the central ray through the infratemporal fossa.
Tooth enamel provides a dense shadow, while dentin and cement provide a less dense shadow. The tooth cavity is determined by the outline of the alveolus and cementum, the root - by the projection of the tooth root and the compact alveolar plate, which looks like a uniform darker strip 0.2-0.25 mm wide.
Well-made radiographs clearly show the structure of the bone tissue. The pattern of the bone is determined by the presence in the spongy substance and the cortical layer of bone beams, or trabeculae, between which the bone marrow is located. The bone beams of the upper jaw are located vertically, which corresponds to the force load exerted on it. The maxillary and frontal sinuses, nasal passages, and orbit appear as clearly defined cavities. Filling materials, due to different densities on the film, have unequal contrast. Thus, phosphate cement gives a good image, but silicate cement gives a poor image. Plastic and composite filling materials do not absorb X-rays well, and, therefore, their image is unclear in the picture.
Radiography makes it possible to determine the condition of hard dental tissues (hidden carious cavities on the contact surfaces of teeth, under an artificial crown), impacted teeth (their position and relationship with jaw tissues, the degree of formation of roots and canals), erupted teeth (fracture, perforation, narrowing, curvature, degree of formation and resorption), foreign bodies in the root canals (pins, broken burs, needles). Using an x-ray, you can also evaluate the degree of patency of the canal (a needle is inserted into the canal and an x-ray is taken), the degree of filling of the canals and the correctness of the filling, the condition of the periapical tissues (widening of the periodontal gap, rarefaction of bone tissue), the degree of atrophy of the bone tissue of the interdental septa, the correct manufacture of artificial crowns (metal), the presence of neoplasms, sequestration, the condition of the temporomandibular joint.
The length of the root canal can be measured using an x-ray. To do this, an instrument with a limiter set at the expected length of the canal is inserted into the root canal. An x-ray is then taken. The length of the tooth canal is calculated using the formula:
K= 
,
Where ^I- actual length of the tool; TO 1 , - radiographically determined length of the canal; I 1 - radiologically determined length of the instrument.
Currently, electronic devices “Detometer” and “Forameter”, etc. are used to determine the length of the root canal. The use of such devices eliminates the patient’s exposure to x-rays.
Methodology bite contact radiography(occlusal) allows you to obtain an image of a section of the alveolar process, including 4-5 teeth, to clarify the spatial features of the pathological focus (impacted tooth, large cyst). It is used to examine children, adolescents, and patients with limited mouth opening and an increased gag reflex. Using this technique, you can assess the condition of large parts of the hard palate, the floor of the mouth, and also detect stones in the submandibular and sublingual salivary glands. It allows you to clarify the location of the fracture, the condition of the outer and inner cortical plates in neoplasms and cysts.
^ Panoramic radiography has become widespread. The peculiarity of this method is that the film simultaneously produces an image of all the teeth and bone tissue of the upper or lower jaw. On panoramic radiographs, the image is enlarged 1.5-2 times and the structure of the bone tissue is clearly displayed. They are used to assess the general condition of the dental system, and determine the condition of the periodontium in the area of all existing teeth. However, to clarify individual details, sometimes it becomes necessary to take “sighted” x-rays (intraoral).
Orthopantomography makes it possible to obtain a 30% enlarged image of curved upper and lower jaws on one film. This allows you to compare the condition of bone tissue in different areas. The method is informative and is recommended for use in cases of injuries, inflammatory diseases, cysts, neoplasms, systemic lesions of the jaws, multiple caries, periodontal diseases, prosthetics and orthodontic treatment.
Radiovisiography is a dental computed radiography, it is performed in compliance with the rules of bisector and tangent. Recently, it has been widely used as an alternative to traditional X-ray examination. The speed of the study, the reduction in the dose of ionizing radiation by 2-3 times, the absence of the need for a darkroom - all these are undoubted advantages of the technique. It should be noted that the image on the computer screen is more informative than the one printed using a printer.
Tomography allows you to obtain an X-ray image of a certain layer of bone and get an idea of the layer-by-layer structure of the tissue. It is used to identify limited lesions located in deep layers.
^ X-ray computed tomography (CT) allows you to identify pathological processes in bone tissue when its density changes by 5%, and conventional radiographs - by 30%. Most often, CT is used for diseases of the upper jaw. The technique makes it possible to determine the spread of the process into the pterygopalatine and infratemporal fossa, the orbit and the bone of the ethmoidal labyrinth.
Zonografiya- layer-by-layer examination with a tube swing angle of 8° in a vertical position of the patient - used to detect effusion and assess the condition of the mucous membrane of the maxillary sinus.
^ Electroradiography (xero-radiography) it is quite informative in identifying traumatic injuries, tumor and inflammatory diseases of the jaws, it is more economical and speeds up the process of obtaining an image. The method is based on removing an electrostatic charge from the surface of a plate coated with selenium, followed by spraying colored powder and transferring the image to paper. On each plate you can get an average of 1000-2000 images. However, the low sensitivity of selenium plates forces an increase in voltage and radiation exposure to the patient, which limits the use of electroradiography when examining children and women.
Sialography- a method of radiopaque or radioisotope examination of the large salivary glands. Contraindications include acute inflammation of the oral mucosa and the excretory duct of the salivary gland, as well as hypersensitivity to iodine. After passing 10 mm with a blunt injection needle, iodolipol, propitodol or water-soluble contrast agents (50-60% hypaque, urografin, etc.), pre-warmed to body temperature, are slowly injected into the duct. Contrast agents are administered until the patient feels the gland is full (usually 0.5-1.0 ml) and then photographs are taken in frontal and lateral projections.
X-rays are used to determine the presence of salivary stones in the duct. In such cases, use a lower exposure.
Using a dental apparatus, it is possible to perform radiographs of the temporomandibular joint, the body and branches of the lower jaw in the lateral projection, radiographs in oblique tangential and contact projections according to Vorobiev and Kotelnikov.
^ Transillumination method
The transillumination method allows you to evaluate the shadow formation observed when a cold beam of light, harmless to the body, passes through the object of study.
The study is carried out in a dark room using an organic glass light guide attached to a dental mirror. The method can be used to diagnose caries, pulpitis, identify subgingival dental plaque, cracks in enamel, as well as to control the quality of preparation of cavities for filling, applying fillings and removing dental plaque from the front teeth.
In transillumination lighting during caries, a brown hemisphere is determined, delimited from healthy tissues. In acute pulpitis, the crown of the affected tooth looks somewhat darker than the crowns of healthy teeth; in chronic pulpitis, a relatively dull glow is observed in the hard tissues of the tooth.
^ Luminescent diagnostics
The luminescent diagnostic method is based on the ability of tissues and their cellular elements to change their natural color under the influence of ultraviolet rays. It can be used to determine the marginal fit of fillings, recognize initial caries, as well as some diseases of the mucous membrane of the mouth and tongue.
For fluorescent diagnostics, the medical industry produces devices (OLD-41) and microscopes equipped with a quartz lamp with a dark purple glass filter (Wood filter).
In Wood's rays, healthy teeth fluoresce with a snow-white hue, while affected areas and artificial teeth appear darker with clear contours. The tongue of a healthy person fluoresces in shades from orange to red. In some people it is noted throughout the tongue, in others it is only in the front part of it. Incomplete glow of the tongue is observed with hypovitaminosis B1. A bright blue glow of the tongue indicates the appearance of leukoplakia. The lesions in the typical form of lichen planus give a whitish-yellow glow, areas of hyperkeratosis in lupus erythematosus, even poorly distinguishable visually, are snow-white-bluish. Foci of congestive hyperemia on the red border of the lips acquire a dark purple color, hyperkeratotic scales look whitish-blue. Erosions and ulcers due to the admixture of blood are dark brown in color, serous-sanguineous crusts are yellowish-brown.
Wood's ray examination is carried out in a darkened room after the eyes have adapted to the dark. The surface under study is illuminated from a distance of 20-30 cm.
In addition to visual assessment of changes in lesions in Wood's rays, fluorescent-histological diagnostic methods are used using fluorochrome and a fluorescent microscope.
^ HYGIENE INDICES
To determine the need for treatment of periodontal diseases, there is the CPITN index proposed by WHO. In this case, it is necessary to examine the surrounding tissues in the area of 10 teeth (17,16,11,26,27, which corresponds to teeth 7,6,1,6,7 in the upper jaw and 37,36,31,46,47, which corresponds to 7 ,6,1,6,7 teeth of the lower jaw).
Index formula 17 16 11 26 27
The condition of only 6 teeth is recorded in the corresponding cells. When examining these teeth, codes corresponding to a more severe condition are involved.
For example, if bleeding is detected in the area of tooth 17, and tartar is detected in area 16, then code-2 is entered in the cell, indicating tartar. If any of these teeth is missing, then examine the tooth next to it in the dentition. If there is no tooth nearby, the cell is crossed out with a diagonal line and does not participate in the summary results.
CPITN is assessed using the following codes:
0-no signs of disease; 1-bleeding gums after probing; 2-presence of supra- and subgingival tartar; 3-pathological pocket 4-5mm deep; 4-pathological pocket with a depth of 6mm or more.
There are indices for the qualitative assessment of various components of the hygienic state of the oral cavity. Green and Vermigliona (1964) proposed the Simplified Oral Hygiene Index (SHI). To do this, determine the presence of plaque and tartar on the buccal surface of the first upper molars, the lingual surface of the first lower molars and the labial surfaces of the upper incisors
| 61 | 16 |
| 6 | 6 |
On all surfaces of these teeth, plaque is first determined, and then tartar. The following ratings are used: 0—no plaque; 1-dental plaque covers no more than 1/3 of the tooth surface; 2-dental plaque covers 2/3 of the tooth surface.
The dental plaque index (DPI) is determined by:
IZN = 
Indicator 0 indicates good hygienic condition of the oral cavity.
The assessment of the tartar index (I.Z.K.) is carried out in the same way as dental plaque:
0-no stone; 1-supragingival stone on 1/3 of the tooth surface; 2-subgingival stone on 2/3 of the tooth surface; 3-subgingival calculus covers 2/3 of the surface of the tooth, subgingival calculus surrounds the neck of the tooth.
UIG=IZN+IZK
When determining the oral hygiene index according to Fedorov-Volodkina, the vestibular surfaces of the 6 frontal teeth of the lower jaw are lubricated with a solution of iodine or potassium iodine. Quantitative assessment is carried out on a five-point scale: staining the entire surface of the crown - 5 points; ¾ surface - 4 points; ½ surface - 3 points; absence of staining - 1 point.
The calculation of the average index value is carried out in the form:
Ksr.= 
An indicator of 1-1.5 indicates good hygienic condition, and an indicator of 2-5 indicates unsatisfactory oral health.
Gingivitis index (I.G.) according to (Loe and Silness, 1967).
The gums in the area of 11, 16, 24, 44, 31, 36 teeth are examined
Index evaluation criteria: 0-no inflammation, 1-mild inflammation.
4|16 (slight change in color), 2 - moderate inflammation (swelling, hyperemia, hypertrophy possible), 3 - severe inflammation (severe hyperemia, ulceration).
I.G. = 
IG interval according to the severity of gingivitis: 0.1-1.0 - mild gingivitis; 1.1-2.0 - average gingivitis; 2.1-3.0 - severe gingivitis.
Periodontal index proposed by Russel (1956).
The severity of inflammatory-destructive changes is assessed. The evaluation criteria are as follows: 0—no changes; 1-gingivitis is mild; 2-gingivitis without clinical pocket; 6-gingivitis with a pocket, the tooth is immobile; 8-pronounced destruction of all periodontal tissues (the tooth is mobile, there is a periodontal pocket).
The severity of periodontitis in accordance with the periodontal index is assessed as follows: 0.1-1.0 - mild; 1.5-4.0 - average; 4.0-8.0 - heavy.
The X-ray method is mandatory in the examination of a patient with periodontal pathology. It allows you to determine the severity of pathological changes in the bone tissue of the jaws and the nature of these changes. Various methods of X-ray examination are used: contact (intraoral), enlarged panoramic radiography, orthoponamography. All these methods complement each other and make it possible to create a clear idea of the pathogenesis of inert changes, their localization and severity.
^ FUNCTIONAL TESTS
1. Blister test characterizes the hydrophilicity of tissues and is used to identify the hidden edematous state of the oral mucosa. It is produced as follows:
0.2 ml. saline solution is inserted with a thin needle into the mucous membrane of the lower lip, gum or cheek directly under the epithelium. A transparent bubble forms, which normally resolves after 50-60 minutes. Accelerated resorption, in less than 25 minutes, indicates increased tissue hydrophilicity.
^ 2.Histamine test. It is used to determine the sensitivity of patients to histamine. 0.1 ml of histamine at a dilution of 1:10,000 is injected intradermally on the flexor surface of the forearm with a thin needle. the formed papule after 10 minutes. Measure in 2 directions and display the average value. Normally, the diameter of the papule is 12 mm. An increase in histamine papules is observed in diseases of the gastrointestinal tract, in recurrent aphthous stomatitis, and in exudative erythema multiforme.
^ 3. Kavetsky-Bazarnova test. 0.1 ml of a 0.25% trypan blue solution is injected into the mucous membrane of the lower lip. The diameter of the spot is measured immediately and 3 hours after its formation. The sample coefficient is calculated as the ratio of the square of the radius of the spot at the time of paint injection to its radius after 3 hours.
Normally, it has a value from 5 to 7, a coefficient below 5 indicates depression, and above it indicates the activity of the functional state of the connective tissue system.
^ 4. Rotter's test. Tissue saturation with ascorbic acid is determined as follows: 0.1 ml of a 0.1% normal solution of 2,6 dichlorophenolindophenol (Tillmans stain) is injected intradermally into the forearm area.
A spot discoloration time exceeding 10 minutes indicates a lack of vitamin C in the body tissues.
^ 5. Kulazhenko’s test. It is based on determining the resistance and permeability of capillaries using dosed vacuum. With pathology, a hematoma on the mucous membrane forms in up to 50 seconds, while normally up to 100 seconds.
6.Capillaroscopy. Used to separate the capillary network of the oral mucosa. Capillaroscopy is performed for periodontal disease, stomatitis, and gingivitis.
7.Rheography. This is a functional method for studying the blood supply to body tissues, based on recording the electrical resistance of tissues when a high-frequency current passes through them.
Using the rheography method, it is possible to identify both the state of the vascular wall and the state of the blood supply to periodontal tissues. For a rheographic study, it is necessary to have an attachment (rheograph), a recording system (electrocardiograph-oscillograph) and electrodes.
^ 8. Polarographic study. Gives an idea of the intensity of tissue respiration by determining the level of oxygen in the gums.
9. Allergy research- carried out to identify sensitization of the body to infectious foci.
The following techniques are used.
Method of application skin tests. Gauze folded in 4 layers (2x2) is soaked in the test solution in a concentration that does not normally cause skin irritation.
This gauze is applied to fat-free, dry skin (usually the forearm), and next to it, under exactly the same conditions, gauze soaked in a solvent is covered with cellophane and fixed with a band-aid. Sample results are taken into account after 24-28 hours. A positive reaction is characterized by the appearance of dermatitis.
Intradermal test technique. The test solution is injected intradermally with a needle or scarification is performed. If the result is positive, then the reaction occurs 5-10 minutes after administration: a bubble appears against a congested background and disappears after 1-2 hours. In this case, only a strip or the needle insertion point is visible in the control area. This test must be carried out with great caution, having anti-shock agents on hand.
Leukotelisis reaction - is based on identifying the deforming effect of bacterial allergens on peripheral blood leukocytes. Specific allergies deform and destroy 14% or more of neutrophils, nonspecific deformation (control does not exceed 10%).
^ Bacteriological research. It was carried out in all cases when it was necessary to clarify the cause of the disease, during purulent processes, to determine bacilli carriage (tuberculosis, syphilis, gonorrhea, leprosy, sectinorrhicosis, fungal diseases).
^ Cytological examination. Based on the nature of the detected cells, it is possible to determine the essence of the pathological process, the state of tissues in a particular disease, their immunity, and reactivity.
^ Biochemical tests of blood and urine. For sugar content in case of clinical suspicion of diabetes mellitus (dry mouth, chronic recurrent candidomycosis, periodontopathy).
In some cases, it is necessary to resort to analysis of gastric juice (for example, if hypo- or vitamin B12 is suspected) to determine phosphorus and calcium in the blood.
^ Clinical analysis. The morphological picture of blood is examined, quantitative and qualitative changes in blood cells are identified, and ROE is determined.
^ Yasinovsky's test. Carry out to count emigrated leukocytes and desquamated epithelial cells in mixed saliva.
Methodology. After brushing the teeth, on an empty stomach, the patient rinses his mouth with 10 ml of isotonic solution, 2 ml per 30 seconds, with breaks of 5 minutes.
The first three portions are spat out, the last 2 portions are collected, diluted three times in physical solution, centrifuged, stained with a 0.1% trypan solution, Kongorot blue solution, then the Goryaev chamber is filled and calculated using the formula: X = a * b, where X is the amount in * g shaped elements, v - number of squares, g - chamber volume. Normally there are 90-150 leukocytes, of which 20% are dead leukocytes and 100 epithelial cells.
Detection of dental plaque is carried out by staining it using the Schiller-Pisarev reagent, a 1-2 percent solution of methylene blue or paint according to a special recipe: zinc iodide - 12.0; crystalline iodine - 40.0; distilled water - 49 ml., glycerin - 80 ml. For this purpose, special tablets are also used abroad, which, dissolving in saliva, stain dental plaque. The use of dyes is convenient when removing dental plaque, since coloring them allows this manipulation to be carried out more thoroughly, without which the use of other therapeutic measures may not give the desired effect.
^ Schiller-Pisarev test refers to the method of intravital staining of gum glycogen, the content of which increases with chronic inflammation. More intense coloring of the gums after smearing it with a solution (crystalline iodine - 1.0; potassium iodide - 2.0; distilled water - 40 ml.) indicates inflammatory phenomena.
Dentistry can be used not only to assess the condition of the gums, but also to monitor the results of treatment of patients, as well as the differential diagnosis of periodontal lesions. To identify ulceration inside the periodontal pocket, the following composition is used: 40% solution of farmolin - 5 ml., glycerin - 20 ml. and distilled water - up to 100 ml. The solution is injected into the periodontal pocket on the turunda or with a syringe. When ulceration occurs, short-term severe pain occurs.
To determine the presence of pus, it is recommended to use the following solution: benzidine - 0.5 grams; polyethylene glycol - 10.0; acetic acid solution 1:1000 - 15ml. One drop of the solution is mixed with one drop of 3% hydrogen peroxide solution and injected into the periodontal pocket on the turunda, it turns green, bluish-green, depending on the amount of pus in the pocket.
^ Determination of the resistance of gum capillaries based on the principle of recording the time during which hematomas form on it. The time during which hematomas occur indicates the resistance of the gum capillaries. According to V.M. Kulazhenko, normally hematomas form in 50-60 seconds. Repeated research makes it possible to determine the dynamics of the process under the influence of treatment.
The depth of the periodontal pocket is measured using a graduated probe.
As for the morphological study of biopsy material, it is very important for making a more accurate diagnosis, and in some cases (eosinophilic granuloma, collagenosis, idiopathic forms of periodontal lesions) is one of the main diagnostic methods.
^ Determining the degree of keratinization of the gums is important because it characterizes the barrier function of the gums. To determine the keratinization index, the total number of keratinized and non-keratinized cells is calculated: the number of keratinized cells is multiplied by 100 and divided by the total number of cells. A decrease in keratinization indicates a decrease in the protective function of marginal periodontium.
To study the distribution and intensity of damage to periodontal tissues, various indices are used, in particular periodontal (P!). The periodontal condition of each tooth is determined by a score from 0 to 8, taking into account the degree of gum inflammation, tooth mobility, and the depth of the periodontal pocket. The resulting scores are added up and divided by the number of teeth present.
In addition to the index (P!), the condition of periodontal tissues can be assessed using the index (PMA). It can only be used to study the initial changes in the periodontium and is therefore called the gingivitis index.
To assess the hygienic state of the oral cavity, a number of indices have been proposed: Fedorov-Volodkin, Fedorov-Volodkin modified by G.N. Pakhomov, simplified hygienic index, Ramferd index (WHO).
^ FUNCTIONAL RESEARCH METHODS
Functional research methods
Functional research methods are auxiliary diagnostic tools. With their help, early, hidden signs of the disease and the stages of its development are identified, indications for pathogenetic therapy are determined, the effectiveness of treatment is monitored, and its outcome is predicted.
Biomicroscopy- study of microcirculation in the oral mucosa based on visual observation. It allows you to measure the linear speed of blood flow in microvessels, the diameter and distribution density of microvessels, and the architectonics of the vascular bed. The method is used for dynamic monitoring of aphthous stomatitis and periodontal diseases.
^ Chewing test carried out to assess the effectiveness of the masticatory apparatus. Three indicators are determined: chewing efficiency, chewing effect and chewing ability.
Polarography- determination of tissue oxygenation. The method is used when there is a violation of the blood supply to tissues (trauma, surgery, periodontal disease, etc.).
Rheodentography- study of the functional state of the vessels of the dental pulp (normal tonic tension of the vascular wall, vasoconstriction, vasodilation). The method is used for differential diagnosis of inflammatory diseases of the dental pulp in the treatment of deep caries, pulpitis using the biological method, tooth preparation for a crown and local anesthesia.
Rheoparodontography- study of periodontal vessels, based on graphical recording of pulse fluctuations in the electrical resistance of periodontal tissues.
Photoplethysmography- determination of local blood flow based on pulse changes in the optical density of tissue. The method allows you to determine the boundaries of the source of inflammation in the maxillofacial area and to monitor the functional state of the vessels of the tongue, lips, cheeks in case of glossitis, stomatitis (the study can be carried out without contact) and periodontitis.
^ Laboratory research methods
Laboratory diagnostics is provided by the use of both general clinical and complex biochemical and morphological methods. A number of functional methods play an important role, allowing one to judge the state of the functions of individual systems, as well as objectively assess the effectiveness of the treatment.
The conclusion about the diagnosis must be based on reliable signs. Examination of a patient, with rare exceptions, involves additional research after questioning and examination.
The doctor draws up a diagnostic conclusion in stages. While questioning the patient, the doctor gets an idea of the nature of the disease, and then, based on the results of the examination, he specifies his assumptions. Additional methods should confirm or clarify them. In some cases, only laboratory and instrumental studies can make a final diagnosis.
The arsenal of diagnostic tools and methods is gradually being replenished with new ones, and old methods are being improved. In dentistry, microscopic and serological studies, diagnosis of drug allergies, as well as general clinical (clinical analysis of blood, urine, etc.) methods are widely used.
^ Microscopic research methods. Methods for studying the microscopic structure of various objects are used in dentistry to determine the cellular structure of the wound surface, qualitative changes in the cells of the mucous membrane, and the bacterial composition of the surface of the mucous membrane or wound. Depending on the purpose, a distinction is made between the cytological method, biopsy and bacteriological examination.
^ Cytological method is based on the study of the structural features of cellular elements and their conglomerates. The method is simple, safe for the patient, quite effective and reliable, allows you to quickly obtain results, and if necessary, you can repeat the study. The cytological method is used to determine the effectiveness of the treatment. In addition, cytological examination can be carried out regardless of the stage and course of the inflammatory process and even on an outpatient basis.
The material for cytological examination can be a smear-imprint, a smear-reprint, a smear-scraping from the surface of the mucous membrane, erosion, ulcers, fistulas, periodontal pockets, as well as sediment from the washing liquid used for rinsing the mouth, and punctate from an area located in the deep-lying tissues.
Strokes-imprints from the wound surface can be obtained in two ways. The first method: well-degreased glass (after long-term storage in 96% ethyl alcohol) is applied to an erosion or ulcer of the oral mucosa, the red border of the lips. However, this method is unacceptable if the ulcer is localized in a hard-to-reach area or the material must be obtained from a deep-lying area of the ulcer. Second method: student gum is cut into long narrow columns with a transverse size of up to 5x5 mm, sterilized by boiling and stored dry. If necessary, a column of gum is applied to the wound surface, and then prints are made on a fat-free glass slide. The disadvantage of these methods is that it is not always possible to obtain the required amount of material; necrotic masses often predominate. Particular difficulties arise when it is necessary to obtain material from the bottom of ulcers, hyperplastic and tumor growths. In such cases, it is advisable to obtain material for cytological examination by smear-scraping. Necrotic masses are removed from the area under study, and then scraping is performed with a dental spatula or trowel. A curettage spoon is used to obtain material from fistulous tracts, from the compacted edges of ulcers, while avoiding getting blood on a glass slide.
For generalized lesions of the oral cavity (gingivitis, periodontitis, catarrhal stomatitis, etc.), as well as to determine the degree of reactivity of the elements of the reticuloendothelial system, the washing liquid sediment after serial rinsing of the mouth according to Yasinovsky.
puncture used, if necessary, to obtain material from an area of compaction, from enlarged lymph nodes, etc. This manipulation is performed with a syringe with a capacity of 5-10 ml, which, after conventional sterilization, is dehydrated with 96% alcohol, and an injection needle 6-8 cm long. The path of the injection needle should be as wide as possible short and safe. When performing a puncture of superficially located tumors and lymph nodes, they are fixed with the thumb and forefinger of the left hand, and the end of the needle is inserted to the desired depth. After this, the area of fabric held by the fingers of the left hand is slightly kneaded, which helps to obtain more material. Then the piston is retracted 1 - 1.5 cm, the syringe with the needle is disconnected, and the piston is returned to its original position. The manipulation is repeated 2-3 times. After obtaining the punctate, the needle is removed from the tissue, the contents of the syringe are squeezed onto a glass slide. One or two drops of the resulting material is usually sufficient to study the cellular composition of tissues in the area under study. If there is a significant amount of blood, smears are made immediately, since it is difficult to prepare satisfactory preparations from the coagulated contents.
The material obtained by any of the specified methods is dried at room temperature (drying in a burner flame or in any other way at high temperature is not recommended, as deformation or destruction of cells may occur). The preparations are fixed in methyl alcohol or Nikiforov’s mixture. Staining is performed with azure-eosin for 25 minutes. For urgent staining, use a 10-fold concentration of azure-eosin solution and treat the preparation with it for 5 minutes.
The cytological picture of acantholytic pemphigus, some viral infections, tumors and tuberculous ulcers has its own specifics. In other diseases (traumatic ulcers, lichen planus, etc.), there are no specific changes in the cells.
There is a rule according to which, when making a diagnosis, one should be guided not only by the results of a cytological examination, but also by clinical data, and when sending material for a cytological examination, the clinical diagnosis must be indicated.
Caution should be exercised when there is a discrepancy between cytological and clinical diagnoses, especially when based on clinical data there is an assumption of the presence of a malignant neoplasm. A discrepancy may be the result of unsuccessful collection of material (incorrect location for obtaining material, too superficial scraping, etc.). Practice has shown that diagnosis is most reliable in cases where the cytologist himself takes the material for research.
The discrepancy between the clinical and cytological diagnoses of pemphigus is an indication for repeated cytological examination. If the presence of a tumor is suspected and the cytological picture is unclear
a repeat examination or biopsy is performed.
The objects of study in therapeutic dentistry are erosions, ulcers, cracks, blisters and blisters. Particular attention should be paid to erosions, ulcers and cracks, characterized by a long course and the presence of signs of hyperkeratosis along the periphery.
The cytological picture of herpes simplex is characterized by the appearance of giant multinucleated cells. It is believed that they are formed as a result of ballooning degeneration, acantholysis and the fusion of a large number of cells due to partial melting of the cell membranes.
In all forms of acantholytic pemphigus, cells typical of this pathology are usually found in the oral cavity - acantholytic pemphigus cells, or Cyanca cells.
Cytological examination of scrapings from tuberculous ulcers reveals a specific picture: cellular elements of the tuberculous tubercle, epithelioid cells, Langhans giant cells, elements of nonspecific inflammation (lymphocytes, neutrophils, plasma cells, macrophages). In addition, the usual microflora of the oral cavity is detected, often a large number of neutrophils.
For cancer of the oral mucosa and red border of the lips, the cytological picture depends on the nature of the tumor. Thus, with an exophytic form of cancer, especially at an early stage, a cytological examination may not reveal signs of the disease. In such cases, when cancer is suspected based on clinical data, a biopsy is indicated. It should be noted that there are no strictly specific morphological features inherent only to a tumor cell, but there is still a set of the most characteristic changes characteristic of malignant neoplasms. The main property of malignant cells is morphological and biological anaplasia. Malignant cells create a picture of cellular and nuclear polymorphism. General criteria for malignancy include changes in the cell, nucleus, nucleoli and some other signs: cell size, its shape, the ratio between the nucleus and the cell, etc.
Biopsy- intravital tissue excision for microscopic examination for diagnostic purposes. It makes it possible to diagnose the pathological process with greater accuracy, since no changes associated with autolysis occur in the material intended for research, when properly fixed. A biopsy is performed in cases where it is not possible to establish a diagnosis using other methods, as well as when it is necessary to confirm clinical assumptions. For a biopsy, it is enough to take a piece of tissue with a diameter of 5-6 mm; if the affected area is small, it is excised completely (total biopsy). The material is placed in a fixing solution and sent for histological examination. The referral includes brief clinical information and a presumptive diagnosis (one or more), since its absence may lead to a diagnostic error.
The clinician should be critical of histological findings, especially if they do not correspond to well-supported clinical data. To avoid diagnostic errors, clinical data are re-evaluated, the material obtained from the biopsy is carefully studied (this is best done by another specialist), and, if necessary, a repeat biopsy is performed.
^ Bacteriological research – bacterioscopy of material obtained from the surface of the oral mucosa, ulcers, erosions. This study is carried out in all cases when it is necessary to clarify the cause of damage to the mucous membrane, in case of specific diseases, purulent processes, to determine the carriage of bacilli. Often it is not possible to establish the cause of an infectious lesion of the mucous membrane due to the presence of a huge number of microorganisms in the oral cavity. The causative agents of a specific infection (syphilis, tuberculosis, gonorrhea, actinomycosis, leprosy, fungal diseases) are also determined using bacteriological studies.
In laboratory practice, microscopy of native and fixed preparations is used. In the first case, the preparations are prepared from fresh, unprocessed material. Slides for preparing preparations must be transparent, clean and grease-free, 1-1.2 mm thick. First, the glass is boiled in a 1% solution of sodium bicarbonate, then washed with water, hydrochloric acid and again with water. Glasses are stored in 95% ethyl alcohol in a jar with a ground stopper or rubbed dry in closed containers.
Bacterioscopy of fixed preparations is more widely used in dentistry to confirm or exclude fungal infections, in particular those caused by yeast-like fungi Candida. These fungi are found in small quantities in the oral cavity as saprophytes in 50% of healthy people.
Detection of treponema pallidum under a dark-field microscope serves as the most reliable confirmation of the diagnosis of primary syphiloma (chancroid). This is the main method of detecting the disease, since serological reactions become positive only 2-3 weeks after the onset of chancre. Treponemas are found in large quantities in papules and erosions in secondary syphilis.
In ulcerative gingivitis and Vincent's stomatitis, in 100% of cases, fusospirochetes are detected, predominant over other microflora.
^ Serological study. Serological methods include methods for studying certain antibodies and antigens in the patient’s blood serum, as well as identifying antigens of microorganisms or tissues for the purpose of their identification, based on immune reactions.
The Wasserman reaction (complement coagulation reaction), Kahn reaction and cytocholic reaction (sedimentary reaction) are used to diagnose syphilis. With syphilis, serological reactions become positive 2-3 weeks after the onset of chancre (5-6 weeks after infection), with secondary syphilis they are sharply positive, and with tertiary syphilis they are positive in 50-70% of cases. It should be remembered that the Wasserman reaction can sometimes be negative even in the secondary period of syphilis. In this regard, in order to avoid mistakes when syphilis is suspected, the dentist is obliged to send the patient for a consultation with a venereologist.
Serological tests identify individuals infected with the human immunodeficiency virus (HIV). If brucellosis is suspected, serological tests of Wright or Huddleson are used.
^ Diagnosis of drug allergies. Diagnosis of sensitization to drugs is quite complex, due to the significant diversity of immunological mechanisms that determine clinical symptoms. In some cases, the reaction is formed by the interaction of the E antigen with IgE fixed on the membranes of polynuclear cells and macrophages (type I allergic reactions). Anaphylactic shock, the formation of blisters, and edema are typical for this mechanism. In other cases, the phenomena of cytolysis predominate due to the interaction of antigen with antibody with the participation of complement components at the level of cell membranes (type II allergic reactions). As a result, hemolysis, leukopenia, and thrombocytopenia develop.
Type III allergic reactions are characterized by the deposition of immune complexes in the vascular wall, which causes the development of the Arthus phenomenon, exanthema with manifestations on the skin and mucous membranes, etc.
Allergic reactions of type IV include syndromes that form manifestations of delayed-type hypersensitivity - cellular reactions with the participation of lymphocytes, for example, drug-induced eczema, contact dermatitis and stomatitis.
Due to the multitype of allergic complications and the layering of nonspecific toxic manifestations, the reliability and effectiveness of diagnostic tests are quite low.
Conventionally, the following main methods for diagnosing drug allergies can be distinguished: collecting an allergic history, performing skin and provocative tests, conducting laboratory tests, including nonspecific and specific tests.
^ Collecting an allergy history - the first stage of the examination, which plays a very important, and possibly the main role in the diagnosis of drug allergies. A correctly collected anamnesis allows you to establish the presence of an allergen and justify the subsequent stages of an allergological examination.
When questioning the patient, you should find out whether he, his parents and relatives have had allergic diseases (bronchial asthma, hay fever, or hay fever, eczema, rheumatism, etc.) in the past. This is important because people who are predisposed to allergic reactions are more likely to experience allergic reactions to medications.
Next, you should find out which drug the patient took for a long time or often, since an allergic reaction most often occurs to repeatedly used drugs; whether there is hypersensitivity to certain foods, pollen, chemicals, insect bites, animal hair, perfumes and other allergens.
The patient is asked about the presence of fungal infections of the skin and nails such as epidermophytosis and trichophytosis. It is known that 8-10% of patients with these diseases may experience acute allergic reactions to the first administration of penicillin due to the presence of common antigenic properties of trichophyton, epidermophyton and penicillin and possible latent sensitization to it. Find out whether the patient has professional contact with medicinal substances and with which ones.
The doctor must evaluate the collected allergy history critically, since the patient’s information is not always objective. Establishing a connection between the clinical manifestations of allergosis and taking a specific drug and their extinction (disappearance) after discontinuation of this drug are the basis for making a diagnosis.
The next stage of allergological examination is performing skin and provocative tests with medicinal substances or serum preparations. Advantages skin tests- ease of setup and recording, accessibility, however, skin tests with medicinal substances cannot be recommended for widespread use, since they cannot be considered absolutely specific and safe.
There are application, drop, scarification and intradermal tests.
The results of skin tests, even if performed methodically correctly, can be either false positive or false negative. False-positive skin tests lead to unreasonable restrictions on the use of a number of effective drugs, and false-negative ones do not guarantee against the development of an allergic reaction after the next dose of this drug.
For an objective assessment of the positive results of skin tests, tests have been proposed that reproduce local eosinophilia and local leukocytosis, which make it possible to statistically reliably distinguish between true and false responses in immediate allergic reactions.
There are also indirect skin tests (Prausnitz-Küstner, Kennedy, Urbaza-Kennigstein test). The essence of these is the intradermal administration of blood serum from a patient to a healthy recipient. After the time required for the fixation of antibodies (reagins) in skin cells, the test allergen is injected into the same area (in the Kennedy test, the order of introduction of the ingredients is reversed). If the patient has an immediate type allergy, hyperemia and infiltration develop at the site of administration of the serum and allergen.
Skin tests are carried out by specially trained nursing staff in outpatient and regular inpatient settings, other tests are carried out in appropriate laboratories and hospitals.
When conducting provocative tests reproduce a local focal reaction by introducing into the patient’s body (during remission) an allergen to which hypersensitivity is assumed.
The following provocative tests are used in dental practice:
sublingual: the allergen is introduced under the tongue and the development of inflammation of the oral mucosa is taken into account;
leukopenic: before and 20-40 minutes after the introduction of the allergen, the number of leukocytes is counted. A decrease in it by more than 1000 cells per 1 mm 3 is an indicator of sensitization to a given allergen;
thrombocytopenic an index based on the agglutination of platelets in peripheral blood by antigen-antibody complexes and a decrease in their number after administration of the allergen.
Non-specific tests:
an increase in the number of eosinophils in the discharge from the site of inflammation and peripheral blood;
thrombocyto- and leukopenia up to agranulocytosis;
an increase in the content of globulins in the serum, especially beta and gamma globulins.
Non-specific tests, allowing to identify the body’s sensitization to certain allergens:
skin and mucosal tests;
cell tests: leukocytolysis reaction, damage indicator
neutrophils, leukocyte agglomeration reaction, platelet agglutination index, basophilic leukocyte degranulation reaction
(according to Shelley), etc.
Of some practical importance in the diagnosis of drug allergies is the study of the pathochemical stage - determination of the content of histamine, serotonin, acetylcholine, heparin, kinins in the blood, as well as assessment of the histamine- and serotonin-pectic properties of blood serum.
The essence of cellular serological and biochemical tests is outlined in special manuals.
It should be noted that skin tests and laboratory research methods are important for diagnosing drug allergies only if the analysis data and clinical manifestations of the disease are taken into account.
To identify sensitization to microorganisms, intradermal tests and laboratory methods (RBTL, RTML, RTMM, PPN, etc.) with the corresponding bacterial allergens are used.
1. Examination of the oral mucosa and skin is necessary for diagnosis:
leukoplaxia;
Bowen's disease;
syphilis;
exudative erythema multiforme.
histological;
allergological;
serological;
biochemical.
serological and biochemical;
biochemical and radiological;
X-ray and cytological.
analysis collection;
examination of the oral cavity;
results of cytological examination.
^ SAMPLES OF SITUATIONAL TASKS FOR LEARNING THE TOPIC
Task 1.
Patient N. 24 years old. complains of pain and mobility of teeth. Teeth 1 and 12 were damaged during a sports competition.
Objectively: the face is symmetrical. 1 and 12 - intact, color not changed. Percussion of these teeth is painful. 1 mobile - 1st degree, 12 - 2nd degree.
What additional examination methods need to be used to establish a diagnosis and prescribe appropriate treatment?
Task 2.
Patient T. 43 years old. complains of soreness in the area of the tip of the tongue. During the examination, the dentist discovered an ulcer. Make a plan for examining the patient.
Task 3.
Patient D., 25 years old, complains of bad breath and prolonged aching pain in 6. What research methods should be used to make a diagnosis?
Task 4.
The patient complains of spontaneous pain in the area of one of the teeth of the upper jaw. Upon examination, no carious cavity was found in the area of the upper jaw teeth. There are 2 fillings on the chewing surface 6 and 7. Make a plan for examining the patient.
Task 5.
Patient D. 24 years old. complains of malaise, weakness, severe bleeding from the gums, mobility of the front teeth and discharge of pus from the gums. What examinations are needed to establish a diagnosis?
^ LITERATURE FOR IN-DEPTH STUDY OF THE TOPIC
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Borovsky E.V., Barer G.M. Guide to practical exercises in therapeutic dentistry. M., 1975.
Borovsky E.V., Kopeikin V.N., Kolesov A.A., Shargorodsky
A.G. Dentistry (guide to practical exercises). M. Medicine. 1987.
Groshikov M.M., Patrikeev V.K. Diagnosis and treatment of dental caries. M., 1978.
Efanov O.I., Dzaganova T.F. Physiotherapy of dental diseases. M., 1980.
Zadgenidze G.A., Shilova-Mechanic P.S. X-ray diagnostics
diseases of teeth and jaws. M., 1962.
Kopelman S.L., Berman L.G. X-ray examination in dentistry. M., 1962.
Maksimovsky Yu.M., Maksimovskaya L.N., Orekhova L.Yu. "Therapeutic dentistry", M., 2002.
Murtazaliev G.-M.G., Abdurakhmanov A.I., Nurmagomedov A.M. “Workshop on endidontics”, M., 2009
Prokhonchukov A.A., Loginova N.K., Zhizhina N.A. Functional diagnostics in dental practice. M., 1980, 1987.
Rasulov M.M., Abakarov S.I., Kurbanova E.A., Murtazaliev G.-M.G., Abakarova D.S., Rasulov I.M. "X-ray diagnostics in dentistry." M., 2007.
Rubin L.R. Physiotherapy. M., 1967.
Rubin L.R. Electroodontodiagnosis. M., 1976.
Rybakov A.I., Ivanov V.S. Clinic of therapeutic dentistry. M, 1980.
Yakovleva V.I., Trofimov E.K., Davidovich T.P., Prosveryak. Diagnosis, treatment and prevention of dental diseases. Minsk, Higher School, 1994.
^ CHECK QUESTIONS FOR LEARNING THE MATERIAL
Diagnostic tests for damage to hard dental tissues.
Tests that determine the resistance of hard dental tissues.
Hygienic indices.
Index of need for treatment of periodontal diseases.
Functional tests.
Allergy tests.
Bacterial study of periodontal disease.
Biochemical study of periodontal disease.
Additional methods of examining a patient in the clinic
Therapeutic dentistry…………………………………………………………….......
Hygienic indices………………………………………………………………
Functional tests………………………………………………………........
Samples of situational tasks for mastering the topic……………………………….
Literature for in-depth study of the topic…………………………………….
Test questions for mastering the material…………………………………….
^
DRUGS 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 explained primarily by social factors: working and living conditions of people, the nature of their diet and environmental changes, insufficient fluoride content in drinking water sources, unsatisfactory oral hygiene and other reasons.
The high prevalence and intensity of caries damage require widespread 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 caused by the interaction of general and local factors. General impact factors include inadequate diet and drinking water, various functional disorders of organs and body systems, as well as the influence of extreme conditions. Local factors: dental plaque (its composition, quantity), 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 played by 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 spot stage (initial caries), superficial, medium and deep.
Initial caries, or caries in the spot stage, is a lesion of the enamel in which its surface layer remains undisturbed. A carious stain can be chalky or pigmented. With superficial caries, a defect in the tooth tissue is formed within the enamel; with average caries, a defect occurs that extends beyond the enamel-dentin junction; with deep caries, 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 spot stage, especially chalk, 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
It is known that regular and thorough removal of dental plaque is important in the prevention of dental caries. To objectively assess the hygienic condition 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, erythrosine in tablets (6-10 mg each), Schiller-Pisarev solution, 2 % aqueous solution of methylene blue.
Magenta(Fuchsini) - fuchsin basic solution. OK-
Turns dental plaque into a crimson color. The drug is used for rinsing.
Rp.: Fuchsini bas. 1.5
Spiritus aethylici 75% 25 ml D.S. 15 drops per l /i glass of water (for rinsing the mouth for 20 s)
Erythrosine(Erythrosin) - red dye of low toxicity. Contains iodine. Available in 4-5 % alcohol solution and tablets (Mentadent C-Plague, Oga] In Einfarb Plagueindika-
Tor, Plague-Farbetabletten, etc.).
Rp.: Sol. Erythrosini 5% 15 ml
D.S. Apply with a cotton swab to the surface of the teeth
Rp.: Tab. Erythrosini 0.006 N. 30
D.S. Chew 1 tablet throughout ^ 1 min
Fluorescein(Fluorescein) is a plaque dye 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. Available under the names “Plak-Lite” (“Blendax”), “Fluorescein” 0.75 %.
^ Schiller-Pisarev solution stains dental plaque yellow-brown. The drug is applied to the surface of the teeth using a cotton swab.
^ Kalii iodidi 2.0
Aq. destill. 40 ml
M.D.S. Schiller-Pisarev solution. Apply with a cotton swab to the surface of the teeth
Methylene blue(Methylenum coeruleum) is used to identify dental plaque: a 1-2% aqueous solution of methylene blue is applied to the surface of the teeth using a cotton swab.
Rp.: Methyleni coerulei 2.0 Aq. dcstiil. 100 ml M.D.S. To lubricate the surface of teeth
^ 2.1.2. Fluorine compounds
Prevention and treatment of the initial stage of caries is carried out using fluoride compounds. Fluorine compounds normalize mineral and protein metabolism, which creates favorable conditions for the mineralization of hard dental tissues and skeletal bones. The administration of fluoride preparations during the period of mineralization of hard tissues helps to increase their caries resistance, which is used when carrying out preventive measures in childhood.
Fluoride compounds enter the body with water and food. The optimal amount of fluoride introduced into the body of an adult is in the range of 1.2-2.6 mg per day, and that introduced into the body of a child is 1.2-1.6 mg.
To prevent dental caries, organic and inorganic fluoride compounds are used. The most commonly used are sodium fluoride, potassium fluoride, tin fluoride, amino fluoride, and titanium fluoride. Fluorides are prescribed locally and orally.
^ Local use 0.05-0.2 % an aqueous solution of sodium fluoride (for rinsing, applications, electro- and phonophoresis), as well as fluoride varnish, fluoride-containing gels and toothpastes.
^ Sodium fluoride(Natrium fluoratum), when applied topically, enters into a chemical combination with one of the main mineral components of enamel - hydroxyapatite, transforming 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 over 6 years of age and for adults as rinses. Rinsing the mouth with sodium fluoride solutions is carried out after meals and brushing teeth in the form of a passage (3 rinses for 1 minute): 0.05% solution
Rum daily, one passage, 0.2 % solution - one passage every 1-2 weeks. Children aged 6-9 years old take 7.5 ml of solution (dessert spoon) for rinsing; those aged 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. The simultaneous use of tablets, sodium fluoride solutions and fluoride varnish is possible.
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 sodium fluoride solution are applied to the surface of the teeth for 4-5 minutes. For a course of treatment there are 4-7 applications (2 times a year).
Rp.: Sol. Sodium fluorati 0.2% 50 mf
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
Fluoride varnish(Phthorlacum) - a composition of natural resins of viscous consistency, dark yellow color, containing 2.9% fluorine. The composition of fluoride varnish includes (per 100 g): sodium fluoride (5 g), fir balsam (40 g), shellac (19 g), chloroform (12 g) and ethyl alcohol (24 g). Insoluble in water, pH 5.25.
The fluoride varnish film is retained on the tooth surface for a long time, saturating the surface layer of enamel with fluoride ions, which contributes to the formation of fluorapatite, which is more durable and less soluble in acids.
To prevent caries, fluoride varnish is used in children aged 7 to 14 years. All teeth are treated with the drug 3 times with an interval of 6 months.
As a therapeutic agent for caries in the staining stage and hyperesthesia of hard dental tissues, fluoride varnish is applied to individual affected teeth 1-2 times a week.
Liu. The course of treatment is 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 tooth surface for 3-5 minutes
To prevent caries, fluoride varnish is used as follows. The surface of the tooth is thoroughly cleaned of plaque and 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 with the teeth of the lower jaw (to avoid the accumulation of saliva). For 4-5 minutes after applying fluoride varnish (until the varnish dries), the patient should not close his mouth. For 12-22 hours, you should only consume liquid food and not brush your teeth. It is recommended to coat the teeth with fluoride varnish three times with an interval of 1-2 days. After 6 months, the procedure is repeated.
For applications use 0.2 % 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 tampons or air. Then loose cotton swabs soaked in 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 using a brush. Upon contact with the surface of the tooth, the gel hardens in the form of a thin film. It is not allowed to eat for 3 hours. Per course - 3-5 applications.
Keep fluorides on the tooth surface. In addition, gels can be applied using impression trays to all teeth simultaneously in one procedure, saving time for the dentist and the patient.
When working with fluoride-containing gels, measures should be taken to minimize patient ingestion of the gel:
use a saliva ejector during application;
limit the amount of gel placed in each custom impression tray to 5-10 drops;
During the procedure, the patient should sit upright with his head tilted forward.
When working with acidic fluorophosphate gels, protective measures should be taken if patients have porcelain dentures in the oral cavity, which can be destroyed by acidic solutions and gels (it is recommended to lubricate them with Vaseline before application).
Currently, many companies produce caries-preventive fluoride-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-gele ("Wypert"), etc.; fluoride-containing varnishes: Fluoridine (“VOCO”), Bifiuorid 12 (“VOCO”), Controcar (“Hammacher”), Duraphat (“Woelm”), Belagel Sa, R, Belagel F, etc.
The high anti-caries effectiveness of acid fluorophosphate gel, which includes
dit 12,300 ppm* fluoride, and rinse liquid “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.).
To prevent caries, special polishing pastes containing fluorides are also used: “Detartrine Fluoree” (“Septodont”), “Proxyt” (“Vi-vadent”), etc. They are used to polish the surface of teeth 1-2 times a year as caries prophylactic agent.
Fluoride gels containing neutral sodium gel (5000 ppm) and tin fluoride (1000 ppm) can be used by patients independently as a caries preventive agent. They are recommended as a means of preventing caries for weekly use over the age of 8 years (Elmex gelee, Blend-a-med gel, etc.).
To prevent caries, a wide arsenal of fluoride-containing toothpastes (with a fluoride concentration of 0.01 - 1%) is used: “Zodiac”, “Karimed”, “Comilfo”, “Ftorodent”, “Cheburashka”, “Remodent”, “Blend-a- med", "Crest", "Blendax", "Elmex", "Signal", "Lacalut", "Binaca", "Pepsodent", "Chlorodent-fluor-forte", "Fluorodent", "Polana", "Copadent" , “Colgate”, “Elgy-fluor”, “Macleans”, “Aquafresh”, etc.
Endogenous Fluoride prevention of caries includes the introduction of fluorides into the body with drinking water, table salt, milk, and fluoride tablets. For mass prevention, it is advisable to carry out fluoridation of drinking water containing fluorine in a concentration of less than 0.5 mg/l. Using fluoride plants in the city water supply, the fluoride concentration is adjusted to 0.8-1.2 mg/l.
For young and middle-aged children, the use of fluoridated milk as a caries preventive agent is effective.
The caries-preventive effect of fluoride has been proven
PPT - part per 1 million (ppm).
Rolled table salt. A normal fluoride concentration should be considered to be 200 mg/kg of salt when several types of salt are fluoridated (for home culinary purposes and for bakeries, restaurants and other food service establishments). This concentration can be doubled only if only salt for home cooking needs is fluoridated.
The effectiveness of caries prevention using fluoride tablets largely depends on the regularity of their use.
The use of sodium fluoride tablets allows you to prevent the formation of caries not only in those teeth that erupted after starting to take 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 between the ages of 2 and 14 years. The required daily dose of the drug is determined depending on the age of the child and the fluoride content in the water of a particular source. Sodium fluoride tablets are taken orally after meals and brushing teeth. The tablet should be chewed and held in the mouth until completely dissolved, then swallowed. It is not recommended to take medications 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 until the age of 14.
The use of sodium fluoride tablets is contraindicated in areas where the fluoride content in drinking water exceeds 0.8 mg/l. Information on the fluoride content in drinking water is obtained from the sanitary-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 danger of acute fluoride poisoning, medicinal packages, usually containing 200-250 tablets, should be kept out of the reach of children.
35
Rp.: Tab. Natrii fluoridi 0.0011 N. 50
D.S. 1 tablet per day (children 2-6 years old)
Rp.: Tab. Natrii fluoridi 0.0022 N. 50
D.S 1 tablet per day (children 7-14 years old)
In Poland, similar Na-trium fluoratum tablets are produced containing 0.001 g of sodium fluoride. This drug is given to children from 3 to 6 years old, 1 Ugh tablets per day, from 6 to 14 years - 2 tablets per day.
Vitaftor(Vitaphthorum) is a combination drug 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 D2) 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 treatment and preventive measures. It is advisable to prescribe it to children living in regions with insufficient fluoride 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. Vitamins A and D2 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-caries effect, is well absorbed, accumulates in dental tissues, bones and, to a lesser extent, in cartilage. Ascorbic acid limits the deposition of fluoride 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 every day. 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 to be carried out 4-6 times a year with a break in the summer months.
The drug is contraindicated when the fluoride content in drinking water is over 1.5 mg/l and in cases 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 ionized form are included in the composition of hydroxyfluorapatite enamel and contribute to its restoration and strengthening. The concentration of ions in remineralizing mixtures should not exceed 3-5%. Remineralization of enamel is carried out in two ways: using applications, as well as electro- and phonophoresis.
To carry out remineralization therapy, a 10% calcium gluconate solution and a 0.2% sodium fluoride solution are used, which are alternately 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 a 10% calcium gluconate solution are applied to the affected area for 15-20 minutes, replacing them every 4-5 minutes with fresh ones.
After every third application with a mineralizing solution, apply a cotton swab moistened with 0.2 % sodium fluoride solution for 2-3 minutes. After completing the entire procedure, it is not recommended to eat for 2 hours. The course of remineralizing therapy consists of 15-20 applications carried out daily or every other day. After completing the course, the surface of the teeth is intact
coat with fluoride varnish accordingly. A repeated course of treatment is indicated after 5-6 months. You can inject a 10% calcium gluconate solution and a 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 a turunda moistened with a solution of remineralizing liquid is placed on the pathologically altered area of the tooth enamel. Current strength is up to 30 μA from the ELOZ-1 or OD-2M device, 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, 0.2% sodium fluoride solution is introduced from the cathode.
The use of Borovsky-Pakhomov remineralizing liquid is also recommended. This allows you to maintain a high concentration of introduced macro- and microelements in the carious spot throughout the entire course of treatment. Electrophoresis is carried out daily for 10-20 days.
Rp.: Sol. Calcii gluconatis 10% 10 ml
D.t.d. N. 20inampull.
S. For applications or electrophoresis on hard dental tissues (introduce from the anode for 20 minutes)
Rp.: Sol. Sodium fluoridi 0.2% 20 ml
D.S. For applications or electrophoresis on hard dental tissues (introduce from the cathode for 2-3 minutes)
Remodent is a very effective means of preventing and treating the initial stages of caries.
Remodent(Remodentum) - a preparation obtained from animal bones; contains a complex of macro- and microelements necessary for the remineralization of enamel. Approximate composition: calcium 4.35%, phosphorus 1.35%,
Magnesium 0.15%, potassium 0.2%, sodium 16%, chlorine 30%, organic substances 44%, trace elements up to 4%. White powder, soluble in water. Upon contact with tooth enamel, the inorganic elements of remodent intensively diffuse 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, helping to restore its structure.
Remodent aqueous solution (3 %) used in the form of applications on a previously cleaned and dried surface of tooth enamel for 15-20 minutes (change tampons 2 times). After application, it is not recommended to rinse your mouth or eat food for 2 hours. The course of treatment for caries 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 are consumed per rinse.
The shelf life of the drug is 3 years, the Remodent solution is stored for no more than 14 days.
The anti-caries drug Remodent is included in the 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 using special materials - dental sealants (sealants). For sealing blind pits and fissures on the chewing surface
The dentures of premolars and molars use polymer and glass ionomer materials.
Modern polymer sealants (sealants) basically contain a monomer matrix bisphenol A-glycidyl methacrylate (BISGMA). Based on the method of polymerization, dental sealants are distinguished between chemical and light curing. Some polymer sealants contain sodium fluoride, which enhances their caries-preventive effect (fissurit F).
To prevent fissure caries, modern polymer 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 blind pits. The use of glass ionomer materials as silantes does not require preliminary acid etching. In addition, fluorides included in glass ionomer cements have a caries preventative 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.) are used.
^ 2.2. DRUGS FOR TREATING CARIES BY FILLING METHOD
2.2.1. Therapeutic pads for deep caries
For the treatment of deep caries, mainly medicinal pads based on calcium hydroxide are 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 included in the treatment pad contains an aqueous solution of sodium carboxymethylcellulose. To prepare a calmecin pad, apply 2-3 drops of the specified liquid to a dry glass plate and add powder to it in small portions until a homogeneous plastic soft mass is obtained. Calmecin curing time is 1-2 minutes. Due to its sharply alkaline reaction (pH “12), the drug has a pronounced anti-inflammatory effect.
Kalyschdont- ready-made paste used for therapeutic pads for 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 syringe of 9 g. After each use, the syringe should be tightly closed, since the paste is hygroscopic.
To treat deep caries, chemically cured linings 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 the Calcimol LC therapeutic pad, the use of materials containing eugenol is not allowed.
Septokal L.Ts.(Septocal L.C.) is a light-curing therapeutic pad containing calcium hydroxyapatite and fluorine. Photopolymerization time is 20 s.
^ 2.2.2. Materials for temporary fillings and gaskets
Temporary filling materials are used to fix medicinal substances in the cavity.
Tooth in the treatment of uncomplicated and complicated caries.
^ Zinc sulphate 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. The hardening of the cement occurs by mixing the powder with water on the rough side of the glass plate.
Zinc sulfate cement powder mixed with eugenol is called dentin paste. It hardens at body temperature within 20-40 minutes. Dentin paste cannot be used to isolate liquid medicinal substances, or as a lining for a permanent filling.
Artificial dentin and dentin paste are used mainly 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. 10 ml
D.S. For preparing artificial dentin fillings
Rp.: Dentin paste 50.0
D.S. For temporary fillings
Tempopro- artificial dentin in the form of a paste made on the basis of zinc sulfate cement. The paste hardens within 2-3 hours. It is used to coat medications in carious tooth cavities, as well as temporary fillings.
^ Zinc phosphate cements used for fixation of various types of fixed dentures, orthodontic appliances, pins and as an insulating gasket to protect the pulp.
Zinc phosphate cements are prepared 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 included in phosphate cement is an aqueous solution of orthophosphoric acid, partially neutralized by aluminum hydroxide and zinc oxide.
The medical industry produces zinc phosphate cements of the following names: Phosphate cement, Visphate cement, Uniface 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 isolating gaskets, fixation of crowns, filling of canals
Mix the powder and liquid on a thick, smooth glass plate with a chrome or nickel-plated spatula. The optimal ratio of powder to 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 taken amount of powder 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 sequentially, mixing thoroughly, 1/4, i/g and V\(, fractions of powder. The mixing time should not exceed 1.5 minutes. 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 thickly kneaded mass.
^ Polycarboxylate cement. 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 compounds 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 is close to neutral (6.5-7.0).
Polycarboxylate cement is used for fixing crowns, inlays, bridges and pins, and orthodontic appliances; as an insulating gasket for fillings made of cement, amalgam, plastic; for filling temporary teeth.
To prepare a filling or lining from poly-carboxylate cement, take powder and liquid 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 mixing duration should not exceed 20-30 s. In order to make maximum use of 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. In terms of its antimicrobial activity, zinc-eugenol cement is approximately similar to 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 drug has low strength. They are used as isolating gaskets, temporary fillings, and also for filling root canals. Zinc-eugenol cement cannot be used as a spacer when filling with composites, since eugenol disrupts the process of their polymerization and thereby worsens the quality of fillings.
Zinc-eugenol cement can be produced ex tempore or its ready-made forms produced by industry can be used (Provicol, 1RM, Fynal).
Rp.: Zinci oxydi 1.0 Eugenolii q.s. M.f pasta D.S. Gasket for deep caries
^ 2.2.3. Materials for permanent fillings
Based on their physical properties, permanent filling materials can be divided into three groups: cements, materials for metal fillings and polymers.
2.2.3.1. Cements
Silicate, silicophosphate and ionomer cements are used as materials for permanent fillings.
Silicate cements. Domestic industry produces Silicia and Silitsin-2. Foreign analogues: Silicap, Alumodent, Fritex. The main ingredient of the powder is silicon oxide. Liquid silicate cement is an aqueous solution of phosphoric acid, additionally containing zinc, aluminum and magnesium phosphates. The introduction of fluoride compounds into 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 and liquid on a smooth glass plate with a plastic spatula. The optimal ratio of powder to liquid varies for different brands from 1.25 to 1.55 g of powder per 0.4 ml of liquid. When mixing, add the powder to the liquid in large portions. Immediately administer half the dose of powder,
Then in 2-3 portions - the remaining amount. The setting time of the cement paste is up to 1 minute.
Silicate cements have a significant toxic effect on the dental pulp, have weak adhesion and insufficient mechanical strength (fragile), therefore they are used for filling carious cavities of classes I and III. An insulating pad must be applied.
^ 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 cement; its toxic properties are less pronounced. Used for filling cavities of classes I and III. When treating medium and deep caries, silylont is used with an insulating pad.
The industry produces silicophosphate cements: silidont and silidont-2. Foreign analogues of silicophosphate cement: Aristos, Lumicon, Fluoro-Thin.
^ Glass monomer cements They 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. Glass monomer cements mixed with water are also produced; in this case, distilled water is used as a liquid for cement.
Glass monomer cements are harmless to tooth tissue and do not irritate the pulp. During the curing process of the material, free carboxyl groups are formed that can bind to 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 flow of fluoride into the hard tissues of the tooth adjacent to the filling, providing an anti-carious effect.
Glass monomer cements are highly sensitive to acids. This property is used to improve the bond between the composite and the gasket.
Glass ionomer cement, for which it is acid etched.
Glass ionomer cement is mixed on special paper plates for 30-40 s. The curing time of the material is on average 3 minutes.
Glass ionomers come in chemical, light and combined curing.
Depending on the purpose, glass monomer cements are divided into the following groups.
L For filling carious cavities of classes I, III and V, wedge-shaped defects and enamel erosions - “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 caries
cavities of baby teeth and fissure sealing
permanent teeth - “lonofil”, “Aqua lonofil”, “Ar
gion", "Ionobond", "lonoseal", etc.
A For applying insulating pads and creating bases 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:
correct ratio of liquid and powder;
Close the bottle with the powder tightly with a lid, as it is very hygroscopic;
Before taking the required amount of powder with a measuring spoon, shake the bottle well to loosen the powder; as 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 filling and an increase in its solubility in 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 curing mechanism of composite materials is the process of converting a monomer into a polymer (polymerization). The mechanism of polymerization, or curing, of fillings made of composite materials can be chemical or light, and therefore a distinction is made between chemical- and light-curing composites.
For chemically cured materials, the polymerization process begins by mixing the catalyst, benzoyl peroxide, and the activator, an aromatic quaternary amine. 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 that includes an activator and a catalyst. Activation of the polymerization process is caused by a beam of light from a photopolymerizer, which is directed onto the surface of the filling.
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 simulate a filling for the required amount of time to obtain the desired result.
Most existing composite materials basically contain a monomeric matrix of BISGMA, synthesized by combining bisphenol-A and glyidyl methacrylate. Some modern composites contain urethane dimethacrylates as a base.
The most important component of composite materials, which determines their basic 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.
^ Macro-filled composites, or macrophiles. They contain particles of inorganic filler ranging in size from 2 to 30 microns. Materials of this group are characterized by sufficient strength, but they are poorly polished, which leads to discoloration of fillings and the formation of microbial plaque, causing 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 restoration of hard dental tissues. Materials in this group include Evicrol, Adaptic, Consise, Heliomolar, Sure Fil, etc.
^ Microfilled composites, or microfills. They have a particle size of mineral filler of 0.02-0.04 microns. Microphiles are well polished and allow you to achieve a good cosmetic effect of a filling, but they are not strong enough. They are used for restoration of the frontal group of teeth in the presence of small defects of hard tissues. Microphilic 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 group of hybrids 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 consists of finely dispersed hybrids with ceramic filler, which accounts for about 80% of the volume. The materials are very durable, flexible, and model well. They have good color range and radiopacity. During their polymerization, fluorides are released into the surrounding hard tissues, which have a caries-preventive effect. This is Tetric-Ceram. Te-Econom. 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 AR and Compoglass. Compomers have good adhesion, as they form a chemical bond with hard dental tissues, are convenient and easy to use, have good aesthetic qualities, and are biologically compatible with dental tissues. During the polymerization process, fluorides are released and enter the hard tissues of the tooth adjacent to the filling, preventing the formation of secondary caries. The technology for working with compomers is fundamentally different from working with composite materials: no acid etching is required, since the material enters into a chemical bond with the dental tissues.
Compared to composite materials, compomers are less durable. They are recommended for restoring cavities of classes III and V, filling erosions, wedge-shaped defects, and also 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. Used for filling cavities of classes I, II and V. Silver amalgam has high strength, ductility, is resistant to moisture, and is not destroyed by saliva in the oral cavity. Its disadvantages include poor adhesion, high thermal conductivity, change in volume (shrinkage) and the presence of mercury in its composition, which can, if the material preparation technology is violated, have a toxic effect on the patient’s body and dental office personnel. However, compliance with the necessary requirements for storage, preparation and work with amalgam completely eliminates the possibility of its toxic effect. The most important condition for safe work with amalgam is the correct dosage of mercury and powder, which is guaranteed by the industrial production of the drug in capsules (single-chamber or double-chamber). Mix the powder and liquid in special amalgam mixers. To work with amalgam, special tools are used: amalgam tray, amalgam plugger, smoother, etc.
Improving the composition of silver amalgam follows the path of increasing the copper content in it and creating finely dispersed spherical particles of a silver alloy, which reduces “2-F as U”, which mainly determines the corrosion and toxic effect of amalgam fillings.
In dental practice, domestically produced silver amalgam 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 (y 2 ).
Rp.: Silver amalgam 50.0
D.S. For preparing permanent fillings
Foreign companies produce silver amalgam (Amalcap) in encapsulated form. Amalcap is used to fill 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 produced by Septodont.
^ Copper amalgam produced by domestic industry: SMTA-56.
Copper amalgam has high strength, ductility, and tight edge fit. However, it has disadvantages: it turns black and is also susceptible to corrosion by acids in the mouth.
What is Schiller's test?
The Schiller test in gynecology is a special research procedure in which the cervix and vaginal areas are treated and stained with an iodine-containing composition to identify problem areas.
In this case, in the normal state, epithelial cells include glycogen, which allows them to absorb iodine and the tissues acquire a brownish color. With certain problems and diseases, the total glycogen content decreases and coloring does not occur.
It is best to carry out the procedure in the first days after the end of the menstrual cycle. During a test in gynecology, strong optical magnification is used, which allows you to examine and determine even minor changes in the shape or color of tissues.
The Schiller test is part of the mandatory examination of women of childbearing age in gynecology. Depending on the results obtained, other procedures may be prescribed: biopsy and types of colposcopy.
Using test data allows you to confirm or refute the diagnosis, as well as develop a further effective program.
The advantages of the test include harmlessness to the cervix and absence of pain.
Inaccuracies in gynecological diagnosis may occur in the following cases:
- Cell tissues do not always come into contact with iodine solution.
- After menopause, certain layers of tissue become thinner and do not stain.
- In case of cervical injuries in the case of a carelessly installed gynecological speculum.
In order for a Schiller test to be prescribed for cervical diseases, there should not be any intolerance to the components contained in Lugol. In gynecology, a solution is used that may contain glycerin or be used without it. This substance has softening properties.
Types of colposcopy
Colposcopy in gynecology can be carried out in a simple or extensive version. The advanced procedure may consist of a variety of tests to provide a more detailed examination.
The following test options are used:
- During the test, the ectocervix is stained with Lugol's composition. The epithelium in its normal state is well stained brown, and any unpainted area is subject to additional examination.
- The Schiller-Pisarev test involves the use of a solution and calcium to lubricate the mucous membrane of the cervix. With its help, the degree of the inflammatory process is determined.
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The Schiller-Pisarev test determines the depth of inflammation, which in gynecology is measured in special points.
Test - diagnosis of cervical pathology
Schiller test. Healthy epithelium is dark brown
The Schiller test is a type of chromodiagnostics used to examine the cervix, during which various dyes are used. The Schiller test is one of the stages of advanced colposcopy.
At the first stage, the cervical epithelium is treated with a low concentrated solution of acetic acid. The second stage is the Schiller test, based on the following phenomenon: normally, glycogen enters the structure of epithelial cells.
It actively absorbs iodine and, accordingly, changes color to dark brown. If there are pathological processes, then the amount of glycogen in the cells decreases, therefore, the color changes poorly or does not change at all.
Indications for the Schiller test
This technique is used when the following diseases are suspected:
- cervical cancer;
- cervical dysplasia;
- suspicion of tumor diseases of the cervix;
- menopause (to eliminate the risk of developing pathological processes).
The Schiller test is done during colposcopy during a gynecological examination. It is recommended for all women to undergo it at least once a year. If the patient is at risk, then the Schiller test is done 2-3 times a year.
Contraindications
The Schiller test is not performed on patients with iodine intolerance.
Methodology for conducting the Schiller test
Using vaginal speculum, the cervix is exposed. A standard colposcopy is performed.
The cervix is cleaned with a cotton ball to remove secretions and mucus. 10-15 ml of Lugol's solution is injected into the vagina (the cervix should be completely immersed in the solution).
Alternatively, the cervix is treated with a tampon soaked in 3% Lugol's solution with glycerin. The solution is removed after 1 minute, and the neck is dried with a napkin or cotton balls.
Then it is re-examined.
Interpretation of Schiller test results
- Normally, in healthy women, after treating the cervix with Lugol's solution, the epithelium is uniformly dark brown or almost black. The endocervix does not change its color.
- If after the Schiller test the tissue is not stained or there is an uneven color distribution, then the colposcopy protocol describes the shape and area of iodine-negative lesions.
- Light specks, round lesions on a uniform dark brown background are a sign of inflammatory disease of the cervix.
- Weak uneven staining is a symptom of atrophic vaginitis.
- Negative Schiller test – erosion of the cervical fundus.
- Also, a negative Schiller test may indicate a colposcopic form of cervical leukoplakia.
- Multilayered areas with uneven staining are a sign of the presence of human papillomavirus infection.
- Often, a negative Schiller test result is characteristic of precancerous diseases of a given organ or the presence of cancer.
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