Study of the oral environment

Determination of pH of mixed saliva. To determine the concentration of hydrogen ions (pH) using kits saliva litmus. The strips have known a certain scale, respectively, indicated under urov¬nyu pH indicator and standard. A strip of paper is introduced into the child's mouth, where it is evenly moistened with saliva for 3-5 seconds. After removing it, vayut compare with the control. The pH of the mixed saliva of healthy children and co-alkalescent fluctuates from 7.0 to 7.4.

Determination of the temperature of the oral mucosa. To measure the temperature, the oral mucosa used medical elektroter¬mometr TCM-2. Scale thermometer allows registering the temperature in the range from 16 ° to 40 ° C, scale 0,2 ° C. To study the surface Glue dyval-point sensor, and then register indicated by the arrow on the scale of temperature. The temperature of the oral mucosa corresponds tempera-round of a healthy child.

Bacterioscopic and bacteriological tests carried out for the refinement of the causes of the disease, the oral mucosa caused by spe- cific-infection. In the laboratory, which receives material from the mouth of a sick child, you can determine the cause of diseases such proyavlyayuschih¬sya in the mouth, such as syphilis, tuberculosis, gonorrhea, actinomycosis, fungal by-disease.

To collect the material using special sterile tubes. Before taking smears rinse your mouth with warm water without using any pharmaceuticals-governmental rinsing the surface element rashes dry gauze there- Ponomarev. Material taken from the depths of the studied lesions close pro¬birku, up direction, indicating a presumptive diagnosis and otprav¬lyayut to the appropriate laboratory.

The content of lysozyme in the saliva mixed determined by enzymatic li¬zisu thereto sensitive bacteria M.lysodeicticus agar diffusion method (K.A.Kagramanova 1964). As the substrate used in the slurry M.lysodeicticus 1% agar.

M.lysodeicticus agar slurry in an amount of 15 ml is made in a Petri dish. After solidification of the agar cut holes which make 0.1 ml of mixed saliva. The medium was incubated at 37 ° C for 20-24 hours. Due to the diffusion of lysozyme is formed transparent zones. Activity is determined by comparing lizo¬tsima diameters in lysis of bacteria standart¬nymi agar solutions of lysozyme and saliva samples tested.

The average content of lysozyme in saliva of healthy children between the ages of 1 month. up to 6 years 59 ± 41,06 mg / ml.

Determination of interferon in the saliva based on the study of its activity by the cytopathic effect of delaying the test virus. To conduct this issledo¬vaniya 2-3 ml of saliva was collected with a sterile rubber balloon and poured into a sterile test tube. Then, to eliminate microflora added 6% hydrochloric acid to pH 2.0 (as interferon and not inactivated at low pH).

The test material is sent to the competent laboratories, usually with virological offices.

In the saliva of healthy children interferon missing.

Determination of quantitative and qualitative composition of the microflora of the oral cavity (G.A.Shalnova, 1962). Filter paper using stationery dy¬rokola prepared wheels (5 mm diameter), which was sterilized with dry heat for ne¬skolko pieces in paper bags. Disc captured and calcined ostuzhen¬nym forceps is applied to a particular portion of the mucous membrane of the mouth po¬losti. Due to the high hygroscopicity of filter paper impregnated with a secret quickly. Thereafter, once the disk is placed in a test tube with 5 ml of sterile isotonic solution. Then, the tube contents were poured into a mortar and triturated with a sterile pestle until disk milling. This emulsification liquid obes¬pechivaet all microbes residing on disk. On solid nutrient media (cups with IPA, blood agar, etc.) produce seeding OD ml of this suspension. After the necessary incubation in an incubator count the number of colonies and produce them ob¬scheprinyatoy identification method. Knowing the area of ​​the disc (19.6 mm2) and defining therein a mass vpitav¬shegosya secretion by checkweighing ve¬sah on torsion disc before and after the print from the mucosa can compute the number mikro¬bov a certain area of ​​the mucosa and a certain amount of her secret.

Determination of the sensitivity of microorganisms to antibiotic mouth is to establish the minimum concentration of drug podavlyayu¬schey microbial growth. Currently, there are two main methods of determining sensitivity of microorganisms: method of diffusion in agar primeneni¬em method of successive disks and serial dilutions in a liquid or solid medium. To collect the material using a sterile swab after koto¬ry swab in a sterile test tube is sent to the bacteriological laboratory.

5.6. Elektroodoreactional study of dental pulp

In order to determine electroexcitability pulp used by electron-troodontodiagnostiki. Carrying out this method by using ap¬paratov OD-1, OD-2.

The study conducted by a doctor with an assistant, who may be a doctor or a nurse.

After applying the active electrode on the investigated tooth at the corresponding points assistant operator turns the knob potentiometer, increasing the current until the threshold of irritation, and visually observes digital dan¬nye. In the study it is necessary to use a plastic spatula. Thus it is necessary to closely monitor the fact that the active electrode from slipping off the sensitive point. As a rule, the study carried out by direct current. In cases when there is no study tooth sensitivity intact even at very high digital data must change polarity, but sometimes the current view. In case of severe polarization when a change polyar¬nosti can not achieve the goal, move on to the study of excitability with po¬moschyu AC.

In studies carried out carious tooth cavity from the bottom, previously washed posled¬nyuyu well dried (the active elek¬trod should be dry). In teeth with large fillings, when mounds are destroyed, or teeth with large, approximo located carious polostya¬mi study is best done with a seal groove, and in the front teeth - with the lingual side of the tubercle.

Electroexcitability permanent and deciduous teeth varies: in the period pro¬rezyvaniya she lowered (or even absent), with the growth and formation of roots excitability increases, reaching normal values ​​at the time of formation of the root okoncha¬telnogo. Electroexcitability teeth, standing outside the arc, does not differ from that of the teeth facing in the dentition, and corresponds to the period raz¬vitiya tooth.

Electroexcitability teeth affected by caries in primary and secondary, vy¬she than intact teeth. Electroexcitability carious fissures significantly higher than intact.

When deep caries depends not electroexcitability cavity depth, and the state of the pulp.

Electroexcitability pulp with pulpitis reduced and corresponds to 18-20 mA at an initial pulp with a total of 40-50 mA and fibrous pulpi¬te and 80-90 mA at the death of the root pulp.

To obtain data on electroexcitability modified pulp razviva¬yuschihsya teeth, it is recommended as the initial use of indicators in-stroke teeth in the same group on the opposite side.

Increase electroexcitability pulp observed in children with malocclusion (open, deep, and others.). "

Electroexcitability milk teeth poorly understood, due to difficulties in obtaining objective information from children under the age of 3-5 years. Electroexcitability intact pulp of deciduous teeth and teeth with various forms of uncomplicated caries is individual for each child. It does not depend on the state of the pulp (normal, inflammation, etc.) and is determined ste¬penyu resorption roots type baby's nervous system, etc. Elektrovoz¬budimost pulp of deciduous teeth with surface caries is 3-9 mA, 5-10 mA, with an average, and with deep caries 7-12 mA.

X-ray study allows to obtain about 80% of all diagno¬sticheskih indicators on the status of various elements of the teeth-chelyu¬stnoy of facial and cranial.

Many of these indicators can not be properly represented without is¬polzovaniya X-ray method.

However, the risk of exposure to ionizing radiation to the growing body of a child makes use it with caution and with a special vni¬maniem relate to methods and techniques of X-ray examination de¬tey and adolescents.

Radiographs of the teeth-jaw system in children should be made on films of good quality, allowing to reduce the maximum recording time. Extraoral shooting must be done by a stationary X-ray appara¬tov with long focal length (at least 1 m), using usili¬vayuschih screens with high resolution, which also allows rez¬ko reduce the radiation dose. Care must be taken to ensure that the field in which the incident X-rays, was severely limited by a diaphragm and do not exceed the recordable area. Iris field on dental¬nyh devices made filters, nested at the base of the tube-lock-analyzer. It should use a different set of filter openings with different thicknesses depending on the Teeth removable group. Stationary rent¬genovskih devices for optical iris is used tsent¬ratory with sliding doors diaphragms.

On dental devices to be used long tubes, localizers, which allow take X-ray tube to 25-35 cm from the skin, reduce the amount of soft scattered rays, providing both when sialography.

Among other special techniques of X-ray studies in pediatric dentistry rarely have to resort to tomography, contrast excretory ducts of the salivary glands, or blood vessels. Scheme issledova¬niya in these cases depends on the character of pathological changes, but printsi¬pialno study design and methods of protecting children from ionizing izluche¬niya not differ from those of adults.

In recent years, the diagnosis of various strains of the teeth-chelyu-stnoy system and the skull all bo¬lee widely used as nazy¬vaemaya teleroentgenography at ko¬toroy on radiographs proizvo¬ditsya series of anthropometric iz¬mereny to determine the size and ratios of the various divisions of the facial and cranial.

Fig. 18. The scheme of the side-we telerentgenogram facial skull.

N - nazion bone, upper Suturae nasofrontalis; Se - the middle of the entrance to the sella; Go - gonion angle of the mandible; Gn - gnation, the deepest point of the bottom surface of the chin; Pog - pogonion, the most anterior point of the mandibular symphysis; ANS (Sna) spina nasatis anterior - front overhang the bottom of the pear-shaped otver¬stiya; PNS (Snp) spina nasalis posterior - gra¬nitsa hard palate at the intersection with fossa pterygo palatina; A - the deepest point pe¬redney surface of the upper jaw at the vertices of the central incisors; B - the deepest point on the front poverhno¬sti body of the mandible; P - porion, na¬ruzhny ear canal line; N-Se - the length of the base of the anterior cranial fossa: SpP - length of the base of the upper jaw; MT1 (Gn-Go) - the length of the lower body chelyus¬ti; MT2 (Go-P) - the length of the branch. ANB - angle protrusion of the mandible; (5 hectares - angles of the central incisors to the base of the jaw; and - mezhreztsovy angle.

The term "teleroentgenography" refers to a method of shooting at a distance bol¬shom focus film. Te lerentgenogrammoy sni¬mok is produced from a distance of more than 2 m. Therefore, experts are used to tsefalometriches-cal low-power research den¬talnye rentgenoapparaty, pozvo¬lyayuschie remove the film is not more than 1.5 m from the focus X-ray tube (namely this distance is accepted as a standard by the Congress of American orthodontists in 1956), essentially telerentgenogramm not receive.

In practice, most tselesoob¬razno use survey with dvuhme¬trovogo distance. Increased in this case is about 8%.

Another important factor to consider when koto¬ry po¬luchenii telerentgenogramm, yavlyaet¬sya scattering object film. Snima¬emaya side adjacent to the cassette, and the opposite spaced therefrom to

13-16 cm. If the X-ray source is a short film by rasstoya¬nii, diverging beam gives a large increase to the opposite side of a release, which is a source of inaccuracies in the data reduction radiographs.

During the X-ray the patient must be motionless. Po¬etomu necessary to use very short exposure, which is only possible in the presence of powerful X-ray machine. The most suitable sledu¬yuschie shooting conditions telerentgenogramm in children and adolescents: 75-90 kV, 80-110 mA, exposure to 0.3. These parameters provide a minimum and oblu¬chenie during radiography.

Upon receipt telerentgenogramm must use kraniostat, ko¬tory must not only the fixing device providing ne¬podvizhnost skull and allow to label its most important parts. Application kraniostata necessary to obtain a series of identical tele¬rentgenogramm dynamics.

Preparation and analysis of only the side telerentgenogramm that ne¬kotorymi practiced orthodontics - the main source of inaccuracies and false vyvo¬dov at telerentgenologicheskom study.

The only way to overcome these errors is the multi-view teleroentgenography. Should produce images in frontal and lateral projections, and the full study design should include and axial radiographs. In this case, it is necessary to use the rear axial projection, which can be removed with the same focal length as the frontal and lateral radiographs.

Telerentgenogramm shooting in all three projections should be made on the size of 24x30 cm kasse¬tah, fully capturing the entire face and cranium. When installing the head of the test is recommended to use the generally accepted rules of packings (Fig. 18).

On the side telerentgenogrammah addition array skull bone, and should be visible to the soft tissues of the face. With proper selection of shooting modes of the image is clear enough. More reliably coat with soft tka¬ni facial midline any radiopaque mixture easier vse¬go thick suspension of barium sulfate. If necessary, you can contrast the language back and back of the throat Lipiodol. During the shooting should za¬schischat body and gonad area studied using prosvintsovannyh aprons or screens.

Telerentgenogramm calculation can be done in different ways: directly on the x-ray film at contact prints from it or by transferring lines osnov¬nyh skull on tracing paper or graph paper with subsequent izmere¬niyami. Use a ruler and a protractor or a specially designed device made of transparent Plexiglas, combining a ruler and protractor.