RU2336803C1 - Method for hypertension and diabetes mellitus detection at dental reception - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patient's mouth cavity is examined to detect any carious cavities, fillings, extracted teeth and to estimate parodentium tissues condition. Then the indices characterizing condition of organs and tissues of the mouth cavity are determined; the ranging of four clinical indices ("РМА", "ИГР-У", "КПУ", "ИЗЗК") is done giving ranks from 1 to 3 depending on the index value. Then numbered estimation is carried out as total score of the ranks in four indices. The total score value less than 8 means low risk of patient's having diabetes mellitus (DM) or hypertension (H). The total score value equal to 9-10 indicates substantial risk of having DM or H. The total score value equal to 11-12 shows higher probability of having H or DM. To determine the diagnostic indices, five groups of people of different age are examined, the 1^st group includes patients having H, the 2^nd group consists of patients having DM, the 3d group - patients with pyelonephritis, the 4^th group - patients having dental deposit in the mouth cavity, the 5^th group - "control group" - people with the same physical status "almost healthy" without any diseases of parodentium and tunica mucosa of mouth.

EFFECT: development of informative and accurate method to detect hypertension and diabetes mellitus at dental reception.

9 tbl, 2 cl

Description

The invention relates to medicine, in particular to dentistry, and is intended to identify at a dental appointment persons at risk of hypertension and diabetes mellitus based on a clinical assessment of the condition of the oral cavity.

The practical activities of each dentist are associated with the treatment of a significant number of patients with a history of somatic diseases. The significance of the problem is determined by the fact that today more than 30% of dental patients have clinically significant somatic pathology. Despite the fact that the possibility of detecting somatic pathology at a dental appointment is constantly discussed, criteria have not yet been identified that allow, with a sufficient degree of probability, to establish the presence of a clinically important somatic disease in a particular patient.

Known methods for diagnosing a number of diseases by examining the oral fluid: desquamative glossitis on the content of norepinephrine (RF application 2004132590, IPC G01N 33/48), odontogenic osteoflegmon and adenoflegmon (RF patent 2230327, IPC G01N 33/84), the inflammatory process in the respiratory system (patent RF 2140080, IPC G01N 33/487), chronic gastroduodenitis and functional dyspepsia in children (RF patent 2270610, IPC AB 10/00, G01N 33/483). Methods are also known for predicting the course of diseases by a number of parameters of the oral fluid, in particular inflammatory diseases (RF patent 2286572, IPC G01N 33/52) and diseases accompanied by disturbance of the microflora of the oral cavity (RF patent 2229130, IPC G01N 33/48). There is also a method for diagnosing the development of myocardial necrosis by the content of arachidonic acid in the blood and saliva (RF patent 2293328, IPC G01N 33/50). All these methods allow you to diagnose the disease by a number of specific parameters of the oral fluid, often requiring sophisticated equipment and qualified personnel to perform analyzes.

Closest to the claimed method is a method for determining the degree of violation of carbohydrate metabolism in diabetes mellitus by the sugar content in saliva (RF application 94038225, IPC АВВ 10/00).

This method is used to clarify the degree of violation of carbohydrate metabolism with a known main diagnosis (diabetes mellitus), requires specific reactions, does not provide the possibility of simultaneous diagnosis of diseases.

The objective of the invention is to develop a method for identifying at a dental appointment persons at risk of hypertension and diabetes mellitus based on a clinical assessment of the condition of the oral cavity.

The specified technical result is achieved by the fact that in the method for detecting hypertension and diabetes mellitus at a dental appointment, a patient examines the oral cavity and reveals carious cavities, fillings, removed teeth, assesses the condition of periodontal tissues; determine the sum of the numbers of carious, filled and extracted teeth (KPU index), as well as the sum of all carious cavities, filled carious cavities and extracted teeth (KPUP index), plaque (ST) and tartar (ZK) on labial surfaces 11 and 13, buccal surfaces 16 and 26, lingual surfaces 36 and 46, which are evaluated according to a four-point system, where 0 - ZN or ZK is not detected, 1 - soft ZN or supragingival ZK covers 1/3 of the tooth, 2 - soft ZN covers 2/3 tooth surface or there is subgingival ZK in the form of separate glomeratov, 3 - ZN mild supragingival or ZK covers more than 2/3 of the tooth surfaces or subgingival ZK surrounds the cervical portion of the tooth; determine the sum of the indicators of six teeth and plaque indices (OUT) and tartar (IZK); determine the hygiene index of the oral cavity IGR-U = GNI + IZK and the papillary-marginal-alveolar index of the PMA; perform ranking of four clinical indicators (RMA, IGR-U, KPU, IZK), assigning ranks from 1 to 3 depending on the value of the indicators; carry out a point assessment as the sum of rank points on four indicators; the total score less than 8 indicates a low risk for dental patients with diabetes mellitus (DM) or hypertension (GB), a total score of 9-10 indicates a significant risk of diabetes or hypertension, the total score of 11-12 shows a very a high probability of having GB or diabetes. To determine the diagnostic indicators and scores characterizing various degrees of risk of hypertension or diabetes mellitus, 5 groups of people of three ages are examined, with 1 group - people with GB, 2 group - with diabetes, 3 group - with pyelonephritis, 4 group - people having dental deposits in the oral cavity, group 5 - control — people with the same somatic status “practically healthy”, without periodontal disease and oral mucosa; for each person, the indices of KPU, KPUP, OUT, IZK, IGR-U and RMA are determined, clinical indicators that have differences between the samples for the examined groups of people are identified, these indicators are ranked with scores from 1 to 3 and the limits of the sum of points of ranks characterizing various degrees are determined risk of hypertension or diabetes.

The method is as follows. Examination of the oral cavity was carried out using a standard set of dental instruments (probe, mirror and tweezers). Participants in the study conducted identification of carious cavities, fillings and extracted teeth, assessing the condition of periodontal tissues, determining the level of oral hygiene, assessing the condition of fillings. The intensity of caries is described by the CPU index as the sum of the quantities of carious (K), filled (P) and removed (Y) teeth. The KPUP index includes the sum of all the carious cavities, the filled carious cavities and the extracted teeth. To assess the hygienic condition of the oral cavity, plaque and tartar were visually determined using a dental probe on labial surfaces 11 and 13, buccal surfaces 16 and 26 and lingual surfaces 36 and 46. Plaque (ST) was evaluated using a four-point system: 0 - ST not found, 1 - soft ST covers 1/3 of the tooth or a dense brown coating in any quantity, 2 - soft ST covers 2/3 of the tooth surface, 3 - soft ST covers more than 2/3 of the tooth surface. OUT = (sum of six teeth): Tartar (ZK) was also evaluated using a four-point system: 0 - ZK was not detected, 1 - supragingival ZK covers 1/3 of the tooth surface, 2 - supragingival ZK covers 2/3 of the tooth surface or there is a subgingival SC in the form of separate conglomerates, 3 - the supragingival SC covers more than 2/3 of the tooth or the subgingival SC surrounds the cervical part of the tooth. IZK = (sum of six tooth indices): 6. The periodontal condition was evaluated using the papillary-marginal-alveolar index (RMA) [Parma S., 1982] - characterizes the state of periodontal tissues. The oral hygiene index was also determined: IGR-Y = OUT + IZK.

In the course of further research, five groups of people were identified:

1) group 1 - patients with hypertension (GB) - 40 people (20%) (see table 1).

Table 1. Index assessment of the state of the oral cavity in patients with GB in various age groups The studied indicators The values of the studied indicators 30-39 years old 40-49 years old 50-59 years old CPU 11.62 ± 4 10.46 ± 4 10.07 ± 5 KPUP 12.54 ± 3 12.69 ± 5 11.86 ± 4 RMA,% 62.53 ± 22 59.62 ± 7 60.07 ± 12 IGR-U, points 1.89 ± 0.52 2.1 ± 0.5 1.78 ± 0.4 OUT, points 0.87 ± 0.5 0.94 ± 0.5 0.84 ± 0.4 IZK, points 1.05 ± 0.6 1.13 ± 0.5 0.94 ± 0.3

2) group 2 - patients with diabetes mellitus (DM) type 2-40 people (20%). A quantitative characteristic of the indices characterizing the state of the organs and tissues of the oral cavity in diabetes in different age groups is presented in table 2.

Table 2. Index assessment of the state of the oral cavity in patients with diabetes in various age groups The studied indicators The values of the studied indicators 30-39 years old 40-49 years old 50-59 years old CPU 10.77 ± 5 9.31 ± 4 7.93 ± 4 KPUP 12.69 ± 3 11.00 ± 3 9.71 ± 1 RMA,% 67.69 ± 10 70.31 ± 8 63.21 ± 10 IGR-U, points 2.1 ± 0.5 2.1 ± 0.5 1.99 ± 0.6 OUT, points 0.85 ± 0.6 0.75 ± 0.3 0.98 ± 0.1 IZK, points 1.26 ± 0.6 1.29 ± 0.4 1.21 ± 0.4

3) group 3 - patients with chronic pyelonephritis (CP) - 40 people (20%) (see table 3):

Table 3. Index assessment of the state of the oral cavity in patients with CP in various age groups The studied indicators The values of the studied indicators 30-39 years old 40-49 years old 50-59 years old CPU 7.62 ± 5 7.0 ± 4 6.71 ± 5 KPUP 9.85 ± 4 8.0 ± 4 8.43 ± 2 RMA,% 32.54 ± 8 32.38 ± 11 31.93 ± 14 IGR-U, points 1.41 ± 0.6 1.52 ± 0.5 1.44 ± 0.5 OUT, points 0.57 ± 0.2 0.65 ± 0.2 0.58 ± 0.2 IZK, points 0.84 ± 0.3 0.88 ± 0.2 0.84 ± 0.4

4) group 4 - people with dental deposits in the oral cavity. The saliva of 40 people (20%) was studied. The results of a clinical examination of the state of the oral cavity in individuals with tartar (NZK) revealed violations of the state of hard tissues of teeth of carious and non-carious origin, as well as a change in the state of periodontal tissues (Table 4).

Table 4. Index assessment of the state of the oral cavity in individuals with NZK in various age groups The studied indicators The values of the studied indicators 30-39 years old 40-49 years old 50-59 years old CPU 6.08 ± 2 4.69 ± 3 4.07 ± 2 KPUP 6.92 ± 2 6.77 ± 3 6.21 ± 3 RMA,% 28.62 ± 7 30.69 ± 7 29.79 ± 10 IGR-U, points 1.24 ± 0.8 1.13 ± 0.3 1.09 ± 0.5 OUT, points 0.64 ± 0.5 0.54 ± 0.2 0.45 ± 0.3 IZK, points 0.62 ± 0.3 0.58 ± 0.2 0.61 ± 0.4

5) group 5 - control group - 40 people (20%). The group of persons resistant to diseases, taken as a comparison, was composed of people with the same somatic status of “practically healthy,” as well as those without periodontal and oral mucosa diseases.

In patients who do not have dental deposits in the oral cavity, the following was established when analyzing the state of the oral cavity (Table 5):

Table 5. Index assessment of the condition of the oral cavity in individuals with a lack of tartar (OZK) in various age groups The studied indicators The values of the studied indicators 30-39 years old 40-49 years old 50-59 years old CPU 3.62 ± 3 4.38 ± 4 5.21 ± 3 KPUP 6.23 ± 5 6.08 ± 4 6.57 ± 3 RMA,% 8.15 ± 7 5.15 ± 4 7.93 ± 2 IGR-U, points 0.8 ± 0.5 0.74 ± 0.3 0.93 ± 0.6 OUT, points 0.8 ± 0.5 0.74 ± 0.3 0.96 ± 0.7

In a comparative study of clinical indices of the state of organs and tissues of the oral cavity in the studied samples, it was found that in individuals in the range of 30-60 years, age is not a factor that can statistically significantly affect the value of the determined indicators.

The results of a clinical study indicate that the most unfavorable situation in the oral cavity develops in patients with diabetes. In such patients, the maximum values of the PMA index are noted, the hygienic condition of the oral cavity is worse. Less adverse, but comparable, is the situation in the oral cavity in patients with GB. With this disease, the highest values of the KPU and KPUP indices were noted. In patients with CP, there were no significant differences from the comparison groups.

The array of information on the clinical condition of the organs and tissues of the oral cavity of the study participants was analyzed from the point of view of identifying the possible diagnostic weight of not a single symptom, but a complex of interrelated signs. The reliability of the results was confirmed using software packages for statistical data processing SPSS 13.0 and StatSoft Statistica 6.0. The hypothesis of differences in the independent samples was tested using the Wald-Wolfbitz criterion (Wald-Wolfbwitz runs lest). To test the hypothesis of differences in dependent samples, the Wilcoxon Matched Pair Test was used.

Preliminary analysis showed that there were differences between the samples for only four clinical indicators - PMA, IGR-U, IZK and KPU. To highlight the limits of potential fluctuations in the absolute values of the studied parameters, the values obtained within the samples were aligned at a minimum for the 25% quartile and maximum for the median and 75% quartile. It turned out that the absolute values of the 25% quartile of PMA in the groups of patients with diabetes and hypertension were more than double that in the groups of patients with CP and control. The absolute values of IHR-U in patients with diabetes and hypertension in all cases, and in patients with CP in two of three age samples also exceeded the control values. The values of IZK and KPU in patients with diabetes and GB also exceeded the corresponding indicators in other samples.

The ratios of the maxima and minima of the absolute values of the studied parameters demonstrated the presence in the groups of patients with hypertension and diabetes mellitus fields of values that do not intersect with other groups (Table 6). The presence of independent fields made it possible to rank the values of the studied indicators depending on the occurrence of limit values in the main group or control group.

Table 6. The absolute values and range of samples depending on the presence of concomitant somatic pathology in the study participants, where M ₁ is the minimum, M ₂ is the average, M ₃ is the maximum value of the indicators in each group. Indices Study groups GB SD HP NZK Ozk M ₁ M ₂ M ₃ M ₁ M ₂ M ₃ M ₁ M ₂ M ₃ M ₁ M ₂ M ₃ M ₁ M ₂ M ₃ RMA 55 61 77 58 63 74 26 32 40 26 32 35 3 8 12 IGR-U 1,6 2.0 2,4 1.7 2.0 2,4 0.9 1,6 1.7 0.5 1.3 1.7 0.5 1,0 1,2 FROM TO 0.7 1,1 1.4 1,0 1.3 1,6 0.6 1,0 1,0 0.4 0.6 0.8 0 0 0 CPU 8 eleven fourteen 6 12 fourteen four 6 10 3 5 7 2 5 7

The performed ranking of indicators (Table 7) made it possible to unify the values of different clinical indicators differing by orders of magnitude.

Table 7. Ranks assigned to the intervals of values of the studied indicators Grades Value Intervals RMA IGR-U FROM TO CPU Rank 1 0-34 0-1,2 0-0.7 0-7 Rank 2 35-55 1.3-1.7 0.8-1.1 8-10 Rank 3 55 and more 1.8 and more 1,2 and more 11 and more

For the convenience of quantifying the estimated intergroup differences, each rank was assigned the corresponding value in points, while it became possible to quantify the point weight of each group studied (Table 8).

Table 8.
Scoring of samples depending on the presence of concomitant somatic pathology and the age of the study participants Indices Study groups (score indexes) GB SD HP NZK Ozk 30-39 years old 40-49 years old 50-59 years old 30-39 years old 40-49 years old 50-59 years old 30-39 years old 40-49 years old 50-59 years old 30-39 years old 40-49 years old 50-59 years old 30-39 years old 40-49 years old 50-59 years old RMA 3 3 3 3 3 3 one one 2 one one 2 one one one IGR-U 2 3 3 2 3 3 one 2 2 one 2 2 one one one FROM TO one 2 one 2 3 3 one 2 2 one one 2 one one one CPU 2 3 3 one 3 3 one one 2 one one one one one one Total points 8 eleven 12 8 12 12 four 6 8 four 5 7 four four four

A total score of more than 8 was found only in groups of patients with hypertension and diabetes. Thus, a total score of 8 or less indicated a low risk for the presence of diabetes or hypertension in the dental patient. The value of the total score of 9-10, taking into account the estimation of the size of the samples, indicated a significant risk of having GB or diabetes (more than 50% of patients with this pathology are concentrated in this area), and the value of the total score of 11-12 showed a very high probability of having GB or diabetes (more 90% of patients with this pathology). Thus, when using the proposed option for the analysis of clinical indicators in an outpatient dental practice, it becomes possible to screen individuals with a high risk of hypertension or diabetes.

To evaluate the results of clinical screening, a blind study of a sample of individuals who had not previously participated in the study was performed. In all patients in a depersonalized mode, a clinical assessment of the state of the organs and tissues of the oral cavity was performed, information about which was entered into a specially prepared study map. After that, an independent expert for each participant in the study calculated the indices of somatic risk for diabetes / GB. Another independent expert carried out a detailed collection of somatic and family history from each study participant, who was also included in the study map. It turned out that the expected as a result of anamnesis and experimental data coincide by 94%. The discrepancy in the results in all cases was formed due to the assignment of a higher score to the study participant compared with the data of the additional survey.

Thus, the assessment of the risk of the presence of somatic pathology by calculating the clinical index has demonstrated high information content with a sufficient level of reliability.

Claims (2)

1. A method for detecting hypertension and diabetes mellitus at a dental appointment, characterized in that the patient examines the oral cavity and reveals carious cavities, fillings, removed teeth, assess the condition of periodontal tissues; determine the sum of the numbers of carious, filled and extracted teeth (KPU index), as well as the sum of all carious cavities, filled carious cavities and extracted teeth (KPUP index), plaque (ST) and tartar (ZK) on labial surfaces 11 and 13, buccal surfaces 16 and 26, lingual surfaces 36 and 46, which are evaluated according to a four-point system, where 0 - ZN or ZK is not detected, 1 - soft ZN or supragingival ZK covers 1/3 of the tooth, 2 - soft ZN covers 2/3 tooth surface or there is subgingival ZK in the form of separate glomeratov, 3 - ZN mild supragingival or ZK covers more than 2/3 of the tooth surfaces or subgingival ZK surrounds the cervical portion of the tooth; determine the sum of the indicators of six teeth and plaque indices (OUT) and tartar (IZK); determine the hygiene index of the oral cavity IGR-U = GNI + IZK and the papillary-marginal-alveolar index of the PMA; perform ranking of four clinical indicators (RMA, IGR-U, KPU, IZK), assigning ranks from 1 to 3 depending on the value of the indicators; carry out a point assessment as the sum of rank points on four indicators; the total score less than 8 indicates a low risk for dental patients with diabetes mellitus (DM) or hypertension (GB), a total score of 9-10 indicates a significant risk of diabetes or hypertension, the total score of 11-12 shows a very a high probability of having GB or diabetes. 2. The method according to claim 1, characterized in that for the determination of diagnostic indicators and scores characterizing various degrees of risk of hypertension or diabetes mellitus, 5 groups of people of three ages are examined, and 1 group - people with GB, 2 group - patients DM, group 3 - patients with pyelonephritis, group 4 - people with dental deposits in the oral cavity, group 5 - control - people with the same somatic status “practically healthy” without periodontal disease and oral mucosa; for each person, the indices of KPU, KPUP, OUT, IZK, IGR-U and RMA are determined, clinical indicators that have differences between the samples for the examined groups of people are identified, these indicators are ranked with scores from 1 to 3 and the limits of the sum of points of ranks characterizing various degrees are determined risk of hypertension or diabetes.