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Dentition score

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20120270182 patent thumbnailZoom

Dentition score


Methods, systems, algorithms, and uses for dentition scores having clinical applicability for an individual patient are described herein. The scores increase as a condition worsens and decrease with treatment. The score can be used to communicate the status of a patient's dentitions to the patient, to an insurer, or to another health care professional.

Browse recent Previser Corporation patents - Mount Vernon, WA, US
Inventors: John A. Martin, Carl F. Loeb
USPTO Applicaton #: #20120270182 - Class: 433215 (USPTO) - 10/25/12 - Class 433 
Dentistry > Method Or Material For Testing, Treating, Restoring, Or Removing Natural Teeth

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The Patent Description & Claims data below is from USPTO Patent Application 20120270182, Dentition score.

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CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. application Ser. No. 12/173,510 filed Jul. 15, 2008. All subject matter set forth in the above referenced application is hereby incorporated by reference into the present application as if fully set forth herein.

BACKGROUND

Dental caries (e.g., tooth decay or cavities) is a disease that affects an individual tooth, which is repaired by restorative treatment when sufficient tooth structure remains to allow for such repair. When caries is sufficiently advanced, an affected tooth is extracted and, if desired, the dentition is repaired by prosthetic treatment that replaces the lost tooth with a prosthetic tooth. Severity is a term that can be used to describe the size of a carious lesion and extent can be used to describe the number of carious lesions in a dentition. In some examples, as shown in FIG. 1, severity can be defined as a linear extension by the depth of penetration from the outer tooth surface to the pulp. Dentist\'s use the carious lesion\'s severity to determine the type of treatment from the categories of preventative, restorative, or endodontic interventions. In some additional examples, severity can be defined by the three-dimensional configuration or volume of tooth structure destroyed, which dentist\'s use to determine if the tooth is restorable and the type of restoration indicated.

Dental caries is site-specific, which means that a dentition may have multiple independent sites of disease and multiple independent treatment interventions. Dentists often describe the status of the patient\'s dentition in very simple terms and from a perspective of treatment need using the number of teeth with caries and the number of teeth that need to be replaced. More sophisticated methods to describe a dentition have been developed for use in dental research but are not typically used for patient communication due to a lack of utility for this purpose. Existing dental indices include Decayed/Missing/Filled Teeth (DMFT), Decayed/Missing/Filled Surface (DMFS), Significant Caries Index (SiC), and Extrapolated Carious Surface Increment Index (ECSI).

DMFT describes the prevalence of teeth affected by dental caries in an individual. It is calculated by adding the number of decayed (D), missing (M), and filled (F) teeth (T). The score range is 0 to 28. The score and its component measures are sometimes used by public health organizations to determine dental status and treatment needs for a population. A DMFT score only increases and does not decrease with treatment. The only direction it can move is higher as the index increases with each tooth newly decayed or missing or filled.

DMFS differs from DMFT by substituting surfaces (S) for teeth (T), which results in a range of 0 to 128 for an adult. The SiC (Significant Caries Index) index is the mean DMFT of the one third of the study group with the highest caries score. The index can be used as a complement to the mean DMFT value.

ECSI (Extrapolated Carious Surface Increment Index) is a caries progression index, which takes into account the enlargement of existing lesions as well as the initiation of new ones.

SUMMARY

In some aspects, the dentition scores described herein can have clinical applicability for the individual patient. Since the score increases as a condition worsens and decreases with treatment, the score(s) can be used to communicate the status of a patient\'s dentition to the patient. Further, and unlike the scores described above, the described dentition scores will decrease as the patient\'s condition improves, thereby encouraging compliance both with restorative and preventive recommendations.

In some aspects, one or both of a caries score and a prosthetic score can be used to communicate dental health status to the patient. The prosthetic score is used to describe the individual\'s status with respect to missing teeth while the caries score describes the health (e.g., presence or absence of caries) for natural teeth. The caries score and prosthetic score can have one or more of the following features which provide the advantage of allowing the score to depict the status of an individual\'s teeth and dentition in a meaningful way. Each score is correlated to a unique set of clinical conditions in a linear manner. The score distinguishes natural health and deviations from natural health (restored health and disease) including the levels within each category where a lower score is indicative of improvement and a higher score denotes deterioration.

These characteristics are shared by the other communicative and universally adopted human descriptive scores, whether developed for health or otherwise. For example, most consumers are aware that their FICO credit score is an important number. If the consumer\'s credit is good, their FICO score is high, if it changes for the worse, the FICO score goes down, and consumers with the same scores will have very similar credit histories. Other examples of meaningful scores would include measurements for blood pressure, cholesterol, blood glucose, Body Mass Index, and the T score. The values associated with these entities have high utility for patients, and are also used to determine treatment needs, and the effectiveness of treatment interventions.

The caries score and the prosthetic score described herein for a dentition describe dental tooth health with a simple numeric score that is useful for communication of the status of the dentition. These scores can provide the advantage of improving the patient\'s understanding of their oral health condition, as well as enhancing the patient\'s participation in the management of their oral health, and/or improving the dentist\'s management of oral health services resulting in better health outcomes.

In some aspects, a method for describing a status of an individual\'s teeth over time includes generating one or both of a caries score and a prosthetic score. The caries score and the prosthetic score increase with increased need for treatment and decrease with effective treatment.

In some aspects, a method for describing a status of an individual\'s teeth over time includes classifying the teeth in an individual\'s dentition based on the status of each individual tooth. The method also includes classifying missing teeth in the individual\'s dentition based on the method of prosthetic tooth replacement. The method also includes determining a number of teeth in an individual\'s dentition that are optimal for the individual. The method also includes determining a number of teeth in an individual\'s dentition that are visible. The method also includes calculating, based on at least some of the classifications and determinations, a caries score associated with the extent of teeth in the individual\'s dentition affected by decay and calculating, based on at least some of the classifications and determinations, a prosthetic score associated with the status of the individual\'s dentition related to prosthetic tooth replacement. The caries score and the prosthetic score increase with increased need for treatment and decrease with effective treatment.

In some additional aspects, a method for generating a caries score for communicating the status of an individual\'s dentition includes retrieving a stored historical caries score for the individual and calculating a caries score based on a current status of the individual\'s dentition. The calculation generates an increased caries score with increased need and decreased caries score with effective treatment. The method also includes comparing the caries score to the historical caries score and communicating a change in the status of the individual\'s dentition based on the comparison of the caries score to the historical caries score where in increased score indicates a worsening condition and a decreased score indicates a decrease in need for treatment.

In some additional aspects, a method for generating a prosthetic score for communicating the status of an individual\'s dentition includes retrieving a stored historical prosthetic score for the individual. The method also includes calculating a prosthetic score based on a current status of the individual\'s dentition. The calculation generates an increased prosthetic score with increased need and decreased prosthetic score with effective treatment. The method also includes comparing the prosthetic score to the historical prosthetic score. The method also includes communicating a change in the status of the individual\'s dentition based on the comparison of the prosthetic score to the historical prosthetic score where in increased score indicates a worsening condition and a decreased score indicates a decrease in need for treatment.

Embodiments can include one or more of the following.

Classifying the teeth in an individual\'s dentition can include classifying each tooth in the individual\'s dentition as one or more of natural, carious, restored, or missing. Classifying the missing teeth in the individual\'s dentition can include classifying each missing tooth in the individual\'s dentition as one of a fixed prosthetic tooth, a removable prosthetic tooth, not replaced but needed for an optimal dentition, or not needed to be replaced for an optimal dentition.

An increasing caries score can be correlated to a worsening condition in which the individual\'s dentition includes an increased number of teeth in need of treatment and a decreasing caries score indicates successful treatment of carious lesions in the individual\'s dentition.

An increasing prosthetic score can be correlated to a worsening condition in which the individual\'s dentition includes an increased number of missing teeth that need to be replaced and a decreasing prosthetic score indicates successful replacement of needed missing teeth in the individual\'s dentition.

Removal of a carious tooth from the individual\'s dentition increases the individual\'s prosthetic score and decreases the individual\'s caries score.

The caries score can include a first digit associated with a percentage of teeth in the individual\'s dentition in need of treatment and a second digit associated with a percentage of teeth in the individual\'s dentition previously treated for a carious condition. The prosthetic score can include a first digit associated with the magnitude of need to replace teeth in the individual\'s dentition and a second digit associated with a percentage of prosthetic teeth that comprise a dentition that is optimal for the individual.

The method can also include storing the caries score and the prosthetic score, repeating, at a subsequent time, the classifying the teeth the an individual\'s dentition, calculating the caries score, and calculating the prosthetic score and generating a graph of the changes in the individual\'s caries score and prosthetic score over time.

Calculating the caries score can also include calculating a percentage of teeth in the individual\'s dentition with caries, calculating a percentage of teeth in the individual\'s dentition previously restored from a carious condition, determining a carious value for carious teeth based on the calculated percentage of teeth in the individual\'s dentition with caries, determining a restored value for restored teeth based on the calculated percentage of teeth in the individual\'s dentition previously restored from a carious condition, and determining the caries score based on the carious value and the restored value.

Calculating the prosthetic score can include determining a percentage of teeth in the individual\'s dentition in need of replacement, determining a value for tooth replacement, and calculating the prosthetic score based on the determined values.

The method can also include providing a table classifying potential caries scores into at least three classifications related to the health of the individual\'s dentition. The at least three classifications can include a first classification including a caries score associated with natural health of the dentition, a second classification including a first range of caries scores associated with previous carious conditions that have been fully restored, and a third classification including a second range of caries scores indicating existing disease and need for treatment.

The method can also include providing a table classifying potential prosthetic scores into at least three classifications related to the health of the individual\'s dentition. The at least three classifications can include a first classification including a prosthetic score associated with an optimal and natural health of the dentition, a second classification including a first range of prosthetic scores associated with previous tooth loss conditions that have been fully prosthetically repaired, and a third classification including a second range of prosthetic scores indicating existing tooth loss that is in need of prosthetic treatment.

DESCRIPTION OF DRAWINGS

FIG. 1 is a diagram depicting a tooth and a severity measurement based on a depth of penetration from the outer tooth surface to the pulp.

FIG. 2 is a table of exemplary dentist observations and input data used to determine a prosthetic score and caries score.

FIG. 3 is a table of calculations used to determine the caries score and the prosthetic score.

FIG. 4 is a diagram of a primary dentition.

FIG. 5 is a diagram of a permanent dentition.

FIG. 6 is table of exemplary caries and prosthetic scores.

FIG. 7 is a flow chart for a method of determining a caries score.

FIG. 8 is an exemplary caries look-up table.

FIG. 9 is an exemplary restored look-up table.

FIG. 10A is a flow chart for a method of determining a prosthetic Score.

FIG. 10B is a flow chart of a method for determining a prosthetic score.

FIG. 11 is an exemplary lookup table used to determine a prosthetic score.

DESCRIPTION

Describing a dentition numerically presents specific challenges that stem from the need for the score to be able to describe the interrelated multi-state status of multiple entities (e.g., teeth). For example, people have only one blood sugar level, one credit score, but most individuals start adult life with 28 teeth. A tooth may be described by one of the following states—natural, restored, carious, or missing where the prosthetic replacement may be by means of a removable denture, fixed bridge, or implant. A simple solution to eliminate caries by replacing all natural teeth with prosthetic teeth would not be understood by the average consumer as the equivalent of a full dentition with no decay or health. The dentition score addresses this challenge by providing two separate scores, a caries score and a prosthetic score, that together comprise the overall status of the dentition and are referred to as a dentition score. The caries score and prosthetic score are both numerical scores. For example, a 1-100 score can be used for the caries score and a separate 1-100 score can be for the prosthetic score. Both the caries score and the prosthetic score increase with increased need and decrease with effective treatment.

The caries score is associated with the status of teeth in the individual\'s dentition affected by decay and the prosthetic score is associated with the status of the individual\'s dentition related to prosthetic tooth replacement. Together the caries score and the prosthetic score can provide an understanding of the health of the dentition. For example, if a patient had rampant caries and no replaced teeth, the caries score would be high and the prosthetic score low. If another patient had only a few teeth where these teeth never had caries and no prosthetic teeth were ever made, the caries score would be low and the prosthetic score high.

The use of multiple scores to describe an aspect of health has precedence as blood pressure includes systolic and diastolic and cholesterol includes HDL and LDL. Similarly, the dentition score includes the caries and prosthetic scores that together describe two related and interdependent components of the dentition. The caries score describes the dentition in terms of the visible teeth affected by decay (e.g., caries and restored teeth). The caries score is a measure of extent and does not include a measure for severity (depth of lesions encountered). A restored tooth is defined as a tooth that has a filling or cap (crown). A caries score of 1 means that the visible teeth have never had decay or been restored. Scores from 2 to 9 mean that all of the visible teeth that had decay have been restored where higher scores correlate to a larger percentage of restored teeth. Scores within the range of 10 to 100 mean that decay exists and restorative treatment is needed where higher scores correspond to more severe conditions and higher restorative treatment need. For scores 10 to 99 the ten\'s digit reflects the increasing percentage of carious teeth and the unit\'s digit is the increasing percentage of restored teeth. A score of 100 represents the most severe condition and highest need. The caries score will decrease upon the completion of all needed treatment to a score in the 2 to 9 range based on the percentage of restored teeth. Furthermore, a tooth that is extracted as an alternative to restorative treatment will be captured by the prosthetic score.

By using both caries and prosthetic scores to describe a dentition\'s status a decrease in the caries score that results from tooth extraction will result in an increase in the prosthetic score. The prosthetic score describes the status of the dentition in terms of prosthetic tooth replacement, which typically is not a treatment intervention that is needed prior to the age of 19 years. Tooth replacement includes removable appliances (e.g., partial and full dentures), non-removable appliances (e.g., bridges), and single tooth replacement implants. A prosthetic score of 1 means that the dentition has the optimal number of natural teeth. Scores from 2 to 9 mean that the dentition has been completely repaired with higher scores indicative of a larger percentage of teeth that needed to be replaced to achieve a dentition that is optimal for the patient. Scores within the range of 10 to 100 mean that prosthetic treatment is needed. Higher prosthetic scores correspond to more severe conditions and higher prosthetic treatment need. For scores 10 to 99, the ten\'s digit reflects the increasing severity of tooth loss and the unit\'s digit is the increasing magnitude of current tooth replacement need. A score of 100 represents the most severe condition and highest need. The prosthetic score will decrease upon the completion of all needed treatment to a score in the 2 to 9 range based on the percentage of teeth that needed to be replaced.

Future treatment needs for the dentition may be determined from the caries score and prosthetic score. These scores are calculated from a limited number of the dentist\'s observations that are first input into the system (FIG. 2) whereupon the system performs calculations using the input data (FIG. 3). For example, a dentist can make the needed observations and enter the observations into a computer system which stores the entered values and uses one or more algorithms to perform the calculations used to determine the caries and prosthetic scores.

As shown in FIG. 2, the inputs to the system based on the dentist\'s observations include an input 100 indicating how many teeth are optimal for the patient excluding third molars, an input 102 of how many natural teeth are visible excluding third molars, an input 104 of how many teeth have any type of restoration including crowns and veneers, and input 106 of how many teeth have caries or defective restoration, and input 108 of how many teeth that have been replaced that are not removable by the patient, and in input 110 of how many teeth that have been replaces that are removable by the patient. In some embodiments, additional inputs may be used to supplement these inputs.

As described above, the system performs calculations using the inputs 100, 102, 104, 106, 108, and 110. As shown in FIG. 3, these calculations can include calculation of a percentage 120 of teeth with caries, a percentage 122 of teeth with a restoration, a value 124 for carious teeth, a value 126 for restored teeth, a number 128 of teeth that should be replaced, a percentage 130 of optimal teeth that should be replaced, a value 132 for tooth replacement, and a value 134 for missing teeth that need to be replaced. In some embodiments, additional calculations may be used to supplement these calculated values. The calculated values 120, 122, 124, 126, 128, 130, 132, and 134 are used to determine the caries score and prosthetic score for an individual (e.g., as described herein).

A risk score for caries determined by a caries risk calculator (e.g., available at the PreViser website) supplements the caries and prosthetic scores so that a complete picture of current and potential needs can be determined. For example, the need and probable cost for future restorative treatment may be determined from the risk for caries and the caries score. Such needs may include restoration of new carious lesions, or replacement of existing restorations which is eventually necessary since every restoration uses materials that have a limited life. The need and probable cost for future prosthetic treatment may be determined from a consideration of the prosthetic score, the caries score and the risk for caries. Elements of this analysis include: 1) the number of prosthetically replaced teeth since every prosthesis uses materials that have a limited life, 2) the number of teeth with a restoration since extraction may be needed when the restoration fails (e.g., restoration or tooth fracture), and 3) caries risk since extraction may be needed when caries is severe. In some examples, an insurance carrier can evaluate the caries score and the prosthetic score when determining a rate and/or deductible to offer for dental insurance for an individual. In some additional examples, an insurance carrier can evaluate mean and/or median caries scores and the prosthetic scores for a cross-section of individuals with similar characteristics (e.g., a particular age range, income level, location, etc) and use the information for when determining a rate and/or deductibles to offer for dental insurance for a particular group of individuals. By viewing the caries scores and prosthetic scores, the insurance carrier can determine an expected cost based on the likelihood of individuals needing dental care above routine dental visits.



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stats Patent Info
Application #
US 20120270182 A1
Publish Date
10/25/2012
Document #
13490577
File Date
06/07/2012
USPTO Class
433215
Other USPTO Classes
International Class
61C19/04
Drawings
11



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