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16послвдуючими ланками патогенезу ХРАС i виник-нення типових для ХРАС ктшчних npoHBiB на групп значних розладiв мiсцевого метаболiзму -афт та виразок.
3. В обгрунтуванш л^вально-профшактич-них заходiв при ХРОС слад враховувати необ-хiднiсть корекцл патогенетичних змiн у СОПР, в тому числ1 судинних pозладiв, гшоксп та порушень метаболiзмy покривних тканин, що забезпечуе вщ-чутний ефект за даними проведеного дослiдження.
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УДК: 616.314.21-007.53:616.314.22-007.54-053.4/.5-06:616.742.4-008.6-036.1-073.75-072-089.23 RELATIONSHIP BETWEEN DISTAL BITE WITH DIFFERENT ETIOLOGICAL FACTORS AND MORPHOFUNCTIONAL CONDITION OF THE JAW-FACIAL AREA
Mykhailovska L.
Postgraduate student of the Department of Dentistry of NMAPE named after P. L. Shupyk
Abstract
The article presents data on negative etiological factors that affect the formation of distal occlusion and the functional state of the maxillofacial area, based on the study of modern literature.
The aim of our investigation is to study in more detail the factors that contribute to the formation of malocclusions.
Keywords: lip closure disorders, mouth breathing, distal occlusion, dental anomalies, bad habits.
According to the publications of domestic and foreign scientists, the issues of etiology, clinic and patho-genesis of distal occlusion become especially relevant because the prevalence of this pathology is rapidly increasing. In the general structure of dental anomalies, the percentage of distal occlusion is about 30% [2, 3, 4, 7, 12].
Bad habits, such as long-term sucking of a pacifier, sucking a finger, other foreign objects, as well as biting the lower lip, play an important role in the formation of distal occlusion. The habit of sucking fingers, mainly the thumb of the right hand, less often the left, is more common than other bad habits. When a bad sucking habit develops, nervous tension and emotional restlessness are important. This habit is more common in breastfed babies, and it often occurs after a baby is weaned or pacifier. Usually children suck their finger when falling asleep and waking up, but, given the significant severity of the bad habit, it is also observed during the night and day. Such children should not be punished, abrupt actions can lead to the child's isolation, stuttering and other disorders of the nervous system [12, 26, 19, 32].
The most typical dental disorders that develop as a result of finger sucking are protrusion of the anterior teeth of the upper jaw and dentoalveolar shortening in this area, which often leads to desocclusion [23].
At long and intensive sucking growth of jaws is broken and the distal bite is formed. The protrusion of the upper incisors makes it difficult to close the lips and promotes mouth breathing. Narrowing of the upper dentition, which occurs as a result of increased negative pressure in the mouth when sucking the thumb, increases. At the same time, the pressure of the buccal muscles on the upper dentition prevails, as the dentition is separated, and the tongue is lowered and adjacent to the lower dentition. A high dome of the palate is formed, the bottom of the nasal cavity is deformed, the nasal septum is curved, which complicates nasal breathing [9, 24].
Many years of bad habit of finger sucking leads to a violation of posture - tilting the head forward, changes in the cervical spine as a result of dysfunction of the muscles surrounding the dentition, as well as intercostal muscles and supra - and infrachioid groups. The conse-
quences of such disorders are a decrease in the vital capacity of the lungs, impaired respiratory function, blood circulation [6, 22].
The habit of sucking and biting the lips is as difficult to correct as sucking the fingers. It is expressed in sucking or biting the lower or upper lip. Often the habit occurs when the protrusion of the incisors of the upper jaw, which contributes to the incorrect location of the lower lip. A sharp nervous overstrain can also serve as an impetus for a strong bite of the lower lip, up to the appearance of wounds on it. Under the influence of this habit there is a vestibular deviation of the upper incisors, the occurrence of dental-alveolar shortening in the anterior part of the upper jaw. Less often, the incisors are bent orally. Often develops distal occlusion or vertical incisal deocclusion, with impaired closure of the front teeth. Occurrence of pain in the temporomandibular joint also causes the habit of biting the lower lip, to keep the lower jaw in a more comfortable position [5, 17, 27, 28].
Sucking the cheeks or pulling them into the mouth and biting often causes the development of symmetrically pronounced occlusion disorders. The habit of sucking the cheeks is often the result of early loss of temporary molars. The habit of keeping the tongue between the rows of teeth can also be observed with a shortened or incorrectly attached bridle. Such disorders cause the development of desocclusion and concomitant functional disorders in the maxillofacial area. Desocclusion caused by sucking the tongue is different from disorders caused by sucking a finger or other objects. It is combined with dentoalveolar shortening on the part of both the upper and lower dentitions [8, 13, 14, 18].
Improper swallowing negatively affects the function of the muscles of the oral and peri-oral areas, the formation of the dental system, can cause prolongation of orthodontic treatment and recurrence of dental anomalies and deformities. Clinical signs of swallowing include increased activity of facial muscles, especially the chin and lower lip muscles. If during swallowing there is a noticeable push of the tip of the tongue on the inner surface of the lip and its subsequent protrusion, then a diagnosis of swallowing disorders is diagnosed. At the same time, the dentition is separated and the height of the lower part of the face increases. If you quickly open the patient's lips while swallowing, you can see the characteristic location of the tip of the tongue between the dentition. The constant anterior position of the tongue contributes to the development of occlusion anomalies, often vertical incisal disocclusion. Lips and cheeks become a support for the tongue. The infantile way of swallowing can be fixed for many years or for life [11, 15, 16, 20, 31].
Respiratory dysfunction is key in the formation of distal occlusion. There are three types of breathing: nasal (physiological), oral and mixed (pathological). The causes of pathological breathing can be different. First, the inability to pass air through the nose due to obstruction of the nasal passages due to curvature of the nasal septum, the growth of polyps, adenoids, hypertrophy of the nasal sinuses, frequent colds, sinusitis, allergic rhinitis. Second, the inability to breathe through the nose
due to a persistent bad habit of breathing through the mouth. Even after eliminating the cause that prevented the passage of air through the nose, the bad habit of breathing through the mouth remains and requires some correction by a doctor. Characteristic signs of oral respiration: non-closing of the lips, disappearance of negative pressure in the oral cavity. Clinically, this manifests itself as sagging of the mandible by reducing the tone of the muscles that raise the mandible, double chin, indicating the sinking of the tongue, non-closing of the lips indicates a loss of tone of the circular muscle of the mouth, which is narrowing of the upper dentition, most expressed in the area of canines and premolars. Oral type of breathing contributes to general disorders in the body. Chronic oral breathing develops in people who endure constant physical activity (professional athletes, dancers, ballerinas). This criterion can be taken into account when collecting medical history from the patient or his parents. With normal nasal breathing and closed lips, the lateral surfaces of the tongue exert sufficient pressure on the upper dentition, and with oral respiration, the tongue occupies the wrong position and does not maintain the normal shape of the upper dentition. The pressure of the buccal muscles on the upper dentition with the mouth half-open causes it to deform. Narrowing of the upper dentition in the area of the canines prevents the normal closing of the dentition. There is a reflex contraction of the posterior bundles of the tem-poralis muscles, the lower jaw is displaced posteriorly, ie distal occlusion develops. If the shape of the upper dentition is not corrected in time, then such a violation is preserved and fixed, hyperactivity of the muscle bundles, displaces the lower jaw back. In most patients with similar occlusal abnormalities, the lower lip is located between the upper and lower front teeth, and children bite it. In case of nasal breathing disorders, many children have adenoid growths on the posterior wall of the pharynx, enlarged palatine-pharyngeal tonsils and other types of pathology of the nasopharynx. With this violation, the nostrils are usually narrow, the nose is wide, the lips are not closed, the contours of the chin are often double. The position of the tongue in the mouth is disturbed: its tip is shifted back, the back is low. The space between the root of the tongue and the soft palate increases [1, 3, 19, 29].
Articulation of the tongue with the surrounding organs and tissues may be incorrect, which is noticeable at rest and, especially, during pronunciation. To identify incorrect speech articulation, the patient is asked to say phrases consisting of words with a large number of hissing sounds. The indistinct pronunciation of these sounds and the location of the tip of the tongue between the dentition indicates improper articulation of the tongue with teeth, lips, palate, which is often combined with dysocclusion. The development and functional state of the tongue significantly affect the development of the dental apparatus, and at the same time the development and function of muscles. Impaired motility of the tongue plays a significant role in the occurrence of dental anomalies. In children, in the process of forming an orthognathic occlusion, with age, the tone of the muscles of the upper lip decreases, and the tone of the muscles of the tongue increases.
However, normally the tone of the muscles of the upper lip always prevails over the tone of the muscles of the tongue. If there is an inverse relationship, then a distal occlusion is formed [6, 12, 21, 30].
The formation of the distal position of the mandible is also facilitated by the temporal type of chewing, with the actual masticatory muscles attached to the temporomandibular joint closer than the masseteric. This anatomical feature leads to an increase in the process of chewing, as a result, food is swallowed in insufficiently crushed form, and the tone of the actual masticatory muscles changes [18].
The formation of distal occlusion is possible due to slow growth and development of the lower jaw caused by trauma, chronic inflammation, congenital absence or death of teeth. The formation of distal, cross and deep occlusion is observed in unilateral underdevelopment of the mandible. The reason for the development of distal and cross occlusion in combination with vertical dysocclusion is bilateral underdevelopment of the mandible.
There is a certain relationship between dental anomalies and disorders of the musculoskeletal system, there is a high prevalence of dental anomalies and deformities in children with posture disorders: their frequency is 1.6, and in patients with scoliosis - 2.5 times higher than in the group almost healthy children, and increases with increasing degree of scoliosis, and there is a direct relationship between their complexity and the degree of scoliosis [25]. Also among the important etiological factors should be noted calcium and fluoride deficiency in the body, insufficient amount of solid food in the diet, early removal of deciduous teeth, jaw injuries and posture disorders [10, 29].
Most authors conditionally divide the characteristic features of distal occlusion into facial and intraoral, which lead to aesthetic and functional disorders. The presence of distal occlusion is accompanied by a change in the profile and proportions of the face due to the protrusion of the upper jaw, underdevelopment or beveled shape of the chin, from which the patient's face sometimes acquires the so-called "bird" appearance. The upper lip is raised, the central upper incisors protrude, the lower lip is behind them. The mouth of a patient with a distal occlusion is slightly open, the lips do not close, the chin fold is sharply outlined. Determining intraoral signs of distal occlusion are the protrusion of the upper front teeth, the presence of a sagittal slit, violation of the relative position of the lateral teeth in the anteroposterior direction. At the same time, with distal occlusion, abnormalities in the position of the teeth, diastema and gothic palate can often be observed. Experts note that distal occlusion is often complicated by open or deep occlusion [21, 26, 32].
Distal occlusion is unfavorable not only for the appearance of the patient, but also for the functioning of the dental apparatus, respiratory organs and articulation. The vast majority of authors note that distal occlusion complicates biting, chewing and swallowing, nasal breathing is disturbed, there is pain in the temporoman-dibular joint. Children with distal occlusion, more often than their peers may have speech disorders that require
speech therapy correction [3, 14]. Patients with a history of distal occlusion have a fairly high recurrence rate: from 60% in cases with tooth extraction and about 75% in clinical situations without tooth extraction [10]. Recurrence after orthodontic treatment is due to the peculiarities of occlusal relationships, genetically determined mismatch in size and shape of the teeth of the upper and lower jaws, continued growth of the jaws, myofunctional mismatch due to redistribution of masticatory muscle tone after orthodontic exercise [11, 22]. It should be noted that in most cases, several factors play a role in the development of occlusion anomalies, which mutually determine each other and are thus linked into a single pathogenetic chain [13, 15, 24].
Conclusion
Analyzing the data of publications of domestic and foreign authors, we can conclude that the timely correction of dysfunction of the dentition and temporomandibular joint is of great therapeutic and prophylactic value and is one of the main tasks of orthodontic treatment of patients in the period of variable occlusion. The most favorable period for the correction of functional disorders is the end of temporary and the beginning of variable occlusion. Comprehensive treatment at this age is important from the point of view of prevention of occlusal pathology and psychological rehabilitation of children, as well as to improve the general condition of the body, balanced growth and development of the maxillofacial area, improve the prognosis of retention of treatment and temporomandibular joint dysfunction in elderly patients.
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