RU2644688C1 - Method for rapid detection of acute inflammatory process in the tooth and surrounding tissues - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry, and can be used for rapid detection of localization of acute inflammatory process in the tooth and surrounding tissues. To do this, the patient is adapted for 15–20 minutes to the environment of the medical room with a constant comfort temperature of +22.5±1 °C. After that, remote sensing of thermal radiation in the infrared region of the spectrum of the symmetrical zones of the teeth on the jaw is performed. If it is established that the temperature in the study zone is higher relative to a healthy symmetrical zone by 2.5–3.5 °C, then diagnose acute inflammatory process in the tooth and surrounding tissues.

EFFECT: method provides accurate, safe, rapid diagnosis of a local acute inflammatory process in the tooth and surrounding tissues and, accordingly, early diagnosis of acute and chronic inflammatory odontogenic processes and monitoring of treatment progress.

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Description

The invention relates to medicine and can be used in dentistry for accurate, safe rapid diagnosis of local acute inflammatory process in the tooth and surrounding tissues.

The effectiveness of the available methods for diagnosing caries and its complications is low due to the psychological age characteristics of patients (children, elderly patients), the emotional state at the time of treatment (in the presence of stomatophobia), concomitant somatic pathology, pregnancy and other contraindications. X-ray machines do not exclude the effect of ionizing radiation on the patient, therefore their use is limited in children and pregnant women.

The dentist experiences the greatest difficulty when searching for a “causative tooth” - a source of acute pain in case of caries complications (acute pulpitis, periodontitis). In such a situation, errors in diagnosis are caused by the presence of 2-3 adjacent damaged or sealed teeth (sometimes the described picture appears on both jaws of one side). A patient, especially a child, in a state of emotional overstrain can most often point only to the side of the source of pain, the irradiation of which along the branches of the trigeminal nerve does not contribute to the exact determination of the jaw, and even more so of a specific tooth (Molofeeva V.A., 2013).

Palpation, percussion, electroodontodiagnosis and thermal testing are often impossible due to inadequate patient behavior at the time of severe pain (Sharova T.N., Antonova A.A., 2012, 2014). X-ray diagnosis in the early period of acute inflammation is most often uninformative or contraindicated (age, pregnancy). An error in the diagnosis is followed by the wrong tactics of the doctor, which contributes to the development of complications and premature extraction of teeth. Thus, the problem of an accurate, safe and non-invasive diagnosis of dental caries complications requires the development of new methods.

Any inflammatory process is characterized by five clinical signs: pain, an increase in local temperature, hyperemia, edema and impaired function. Pain is a highly subjective factor, and changes in local temperature can be recorded in objective ways. Arterial hyperemia and increased heat production in the focus of inflammation due to increased metabolism are involved in the mechanism of increasing local temperature (V.K. Leontyev, L.P. Kiselnikova, 2010).

Known electroodontometric method (EDI) for the diagnosis of caries and its complications, based on a comparison of the electrical resistance of tooth tissues in normal and pathological conditions, the method requires extremely adequate patient behavior and "correct" interpretation of subjective sensations, which excludes the use of this method in patients with stomatophobia and children. Thus, the method has a number of disadvantages and contraindications, which significantly limits the diagnostic capabilities of the dentist (Suntsov V.G., Skripkina G.I., Matskieva O.V., Samokhina V.I., 2009).

For the closest analogue, a method has been adopted that allows you to measure the temperature of any surface of a tooth crown using a thermistor with high ohmic resistance (Bolshakov G.V., 1972; Nefedova MV, 1974). This device ("Odontothermometer") was developed for orthopedic dentistry in order to assess the condition of teeth prepared for fixed prosthesis structures, as well as to develop rational methods for preparing teeth to minimize thermal injury. Disadvantages of the analogue: the contact of the thermistor with the studied area, inaccuracy, inertia of the device, cumbersome, not ergonomic, the presence of contraindications for use (cardiac arrhythmias and inapplicability in the presence of a pacemaker).

Tasks: increasing the effectiveness of dental treatment, reducing the number of complications and medical errors and eliminating adverse side effects.

A fundamentally new method of accurate, safe rapid diagnosis of acute inflammatory process in the tooth and surrounding tissues is proposed, based on the principles of thermography. Thermography is a method of recording infrared radiation of a human body in order to diagnose various diseases. A change in the normal distribution of temperatures is a sign of a pathological process. An increase in the intensity of infrared radiation over pathological foci is associated with an increase in blood supply and metabolic processes in them, a decrease in its intensity is observed in the region with reduced regional blood flow and concomitant changes in tissues and organs.

There are no contraindications to thermography, the study can be repeated many times ((Zhulev EN, Velmakina IV, 2015). The method involves performing non-contact measurement of the temperature of the tooth surface using a graduated or color scale and a reference emitter.

The essence of the invention is that they perform remote sensing of thermal radiation in the infrared region of the spectrum of the symmetrical zones of the teeth on the jaw and determine the acute inflammatory process in the tooth and surrounding tissues, the temperature of which is 2.5-3.5 ° C higher than the healthy symmetrical zone .

Before the study, the patient needs to adapt to the ambient temperature, for which the patient should be freed from warm clothing 15-20 minutes before the study, the cabinet should have a constant comfort temperature (+ 22.5 ± 1 °), which is assumed by the sanitary and hygienic standards of medical premises. Analysis of the data of tooth thermometry includes their automatic quantitative assessment (with the determination of the temperature difference of the studied tooth in comparison with a healthy tooth of the same group belonging on the other hand, with surrounding tissues). The presence of a pathological process corresponds to a change in the temperature gradient in the studied area. It was found that the temperature gradient of the zone of hyperthermia (in acute and chronic inflammatory processes) and a symmetrical healthy region in the oral cavity is 1.5-3.5 ° C.

The obtained temperature data of different groups of intact teeth (temporary and permanent) and the surrounding periodontium:

- More than 300 patients with the leading symptom of “acute pain” were examined and recorded temperature indicators of “sick” teeth and the surrounding periodontium;

- obtained and statistically determined average temperature values of the dento-periodontal complex in normal and with inflammation to develop the input parameters of the diagnostic algorithm of the program-analytical part.

Patients with diagnoses were examined: acute partial, general, purulent, chronic pulpitis, acute and chronic periodontitis, periodontal abscess (at least 30 cases of each nosological form).

Done:

- measuring the temperature of the natural crown of the tooth and the surface of the alveolar bone in the area of the root projection (carried out the same way for healthy teeth and with visible pathology), taking into account the first measurement indicators, since the surface of the tooth and the alveolar bone undergo drying out due to the evaporation of the oral cavity liquids, which leads to a decrease in temperature indicators.

In the area of the pathological process, a temperature change was reliably established:

- in the zone of permanent teeth with acute purulent inflammation and a symmetrical healthy area, the difference in temperature is 2.5-3.5 °;

- in the zone of permanent teeth with acute serous inflammation and a symmetrical healthy area, the difference in temperature is 2.5-3 °;

- in the zone of permanent teeth with chronic inflammation and a symmetrical healthy area, the difference in temperature is 1.5-2 °;

- in the area of temporary teeth with acute inflammation and a symmetrical healthy area, the difference in temperature is 3-3.5 °;

- in the area of temporary teeth with chronic inflammation and a symmetrical healthy area, the difference in temperature is 1.5-2 °.

The proposed method has several advantages:

- Non-invasiveness - the method eliminates the violation of the integrity of the tooth tissues and surrounding tissues.

- Non-contact use of the method - eliminates contact with blood and saliva.

- The speed of the manipulation is an instant result.

- Psychological comfort - the patient does not experience any pain or discomfort.

- The objectivity of the method is the exclusion of subjective decision-making and thus minimizing diagnostic errors.

- Ergonomics and mobility of the device with which diagnostics are performed.

Effect: the use of a device of this class in medicine allows for the early diagnosis of acute and chronic inflammatory odontogenic processes and monitoring the course of treatment.

The method was tested in a laboratory and clinic, since the thermodiagnostics is absolutely harmless (Zhulev E.N., Velmakina I.V., 2015), there are no contraindications for it (the device does not emit anything, but only registers infrared radiation). The method showed stably accurate measurement results.

The method is as follows: the patient is preliminarily adapted to the environment by placing him for 15-20 minutes under conditions corresponding to the sanitary and hygienic standards of medical facilities, after which remote sensing of thermal radiation in the infrared region of the spectrum of the symmetrical zones of the teeth on the jaw is performed and determined by a change in the temperature of the tooth, the presence of an acute inflammatory process in the tooth and surrounding tissues, where the temperature (in the presence of acute inflammation) is always higher by 2.5-3.5 ° C relatively symmetrical zone without acute inflammatory process.

Example 1

Patient K., 7 years old, accompanied by his parents, turned to the children's dental department of the joint venture of KubSMU because of acute pain in the upper jaw on the left. The patient, according to his mother, had a comorbid pathology from the sphere of neuropsychiatric disorders (oligophrenia in the stage of debility).

Anamnesis of the disease: pain bothers the day, painkillers give a short-term effect. Pain at rest and while eating.

Objectively: the configuration of the face is not changed. Normal skin color. Submandibular lymph nodes are palpated on both sides. Opening the mouth is not limited. In the oral cavity: decompensated form of caries (photo 1. in the annex to the application), acute course, on the upper jaw on the left 61, 62, 63, 64 teeth have the same degree of destruction, when probing the cavity of the tooth it is slightly painful, percussion reaction is positive in all of the above teeth. The patient's comorbid status implies an inadequate response to diagnostic manipulations. An X-ray examination displays damage to the hard tissues of the listed teeth, bone destruction and periapical foci are not detected. For additional diagnosis, the proposed method for the rapid detection of acute inflammatory process in the tooth was used, with the help of which all four teeth located in the area of inflammation were examined. The sound signal of the device (triggered by an increase in the local temperature in the area of the diseased tooth) appeared when the infrared sensor was pointing at the crown of the 63 tooth, and the temperature of the examined tooth appeared on the display (33.0 ° C), which determined the cause of the pain - 63 tooth. Normally, the temperature of the intact 63 tooth is 30.5 °. Thus, an increase in the temperature of the examined tooth by 3.0 ° allows us to ascertain the presence of an acute inflammatory process in 63 teeth. After analyzing the data of clinical, radiological and thermometric studies (the proposed method of rapid diagnosis), the final diagnosis is an exacerbation of chronic pulpitis of 63 teeth. After appropriate endodontic treatment of 63 teeth, the pain syndrome stopped.

Example 2

Patient M., 22 years old, turned to the dental clinic of KubSMU because of the constant spilled acute pain in the region of the lower jaw and radiating along the branches of the trigeminal nerve into the upper jaw and temple, which is poorly stopped by analgesics.

Anamnesis of the disease: pain worries for 2 days, pain medications give a short-term effect. The intensity of pain does not depend on food intake and time of day.

Anamnesis of life: according to the patient, pregnancy is 6-8 weeks.

Objectively: the configuration of the face is not changed. Normal skin color. Submandibular lymph nodes are palpated on both sides. Opening the mouth is not limited. In the oral cavity: a decompensated form of caries (photo 2 (a) in the appendix to the application), on the upper jaw on the right, all the teeth of the chewing group have externally consistent fillings of classes 1 and 2, percussion is negative, the transitional fold in the area of the chewing teeth of the upper jaw on the right is palpation of normal color, painless. Chewing teeth on the lower jaw on the right (47, 46, 45) in color have changed, have extensive fillings, covering more than 70% of the area of each of the listed teeth. The percussion reaction in 47, 46, 45 teeth is equally positive, the transitional fold is painful on palpation, slightly swollen, unchanged in color. X-ray examination is contraindicated due to the first trimester of pregnancy. For additional diagnostics, the proposed method for the rapid detection of acute inflammatory process in the tooth was used, with the help of which 47, 46, 45 teeth that were in the proposed area of inflammation and had a similar clinical picture characteristic of the “causal” tooth were examined (photo 2 (in ) in the appendix to the application). The sound signal of the device (triggered by an increase in the local temperature in the area of the diseased tooth) appeared when the infrared sensor was pointed at the crown of the 46 tooth, and the temperature of the examined tooth appeared on the display (34.5 ° C), which determined the source of pain - 46 tooth. Normally, the temperature of the intact 46 tooth is 31.0 °. Thus, an increase in the temperature of the examined tooth by 3.5 ° allows us to ascertain the presence of an acute inflammatory process in 46 teeth. After analyzing the data of clinical and thermometric studies (the proposed method of rapid diagnosis), the presumptive diagnosis is an exacerbation of chronic periodontitis of 46 teeth. After the surgical treatment of 46 teeth (removal), the pain syndrome and the inflammatory process stopped without additional drug antibiotic therapy. Radical cysts with purulent contents were visualized in the apical sections of the extracted tooth, which made it possible to verify the final diagnosis - a radicular cyst of the 46th tooth in the suppuration stage (photo 2 (b) in the appendix to the application).

Information sources

1. Bolshakov G.V., Nefedova M.A. The change in surface temperature of the crown of the prepared tooth // Results of clinical and experimental studies of MMSI. - M., 1974. - S. 37-38.

2. Bolshakov G.V. Tooth reaction to thermal irritation during preparation // Changes in periodontal tissues before and after dental prosthetics. Conf. Materials - M., 1972.P. 98-100.

3. Bolshakov G.V., Spitsyna N.P., Patrina S.V. Clinical characteristics of the functional state of teeth // Prevention and treatment of major dental diseases. Izhevsk, 1992 .-- S. 18.

4. Pediatric therapeutic dentistry: national guidelines / ed. VK. Leontiev, L.P. Kiselnikova. - M .: GEOTAR-MED, 2010 .-- 896 p.

Claims (1)

The method of rapid detection of localization of acute inflammatory process in the tooth and surrounding tissues, including measuring the temperature of the tooth, characterized in that the patient is pre-adapted for 15-20 minutes to the environment of the medical room with a constant comfort temperature of +22.5 ± 1 ° C, after which remote sensing of thermal radiation in the infrared region of the spectrum of the symmetrical zones of the teeth on the jaw is performed and, if it is established that the temperature in the study area is higher than a relatively healthy system the metric zone at 2.5-3.5 ° C, diagnose an acute inflammatory process in the tooth and surrounding tissues.

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