02 января 2016г.
Appearance of temporal-mandibular joint (TMJ) pain dysfunction is connected with different reasons. Tooth- maxillofacial anomaly and deformity play a special role. Pain and deformity of temporal-mandibular joint is motivation for adults to consult a stomatologist-orthodontist. Difficulty of TMJ dysfunction clinical finding is being worsened by pathologic occlusive relations between teeth rows and bite condition [2].
Some authors [4,5,6,7] emphasize the main role of occlusive relations disorder in formation of muscular-joint dysfunction of TMJ.
Occlusive disorders can not only promote appearance of pain dysfunction syndrome, but complicate its course. At the same time, symptoms of intra-articular disorders can appear without changes in teeth relations. Occlusive disorders correction doesn’t always promote dysfunction syndrome elimination, its effect is often short [7].
In 1982 M. D. Gross and J.D. Mathews paid their attention to the combination of two main factors forming TMJ disease. Emotional and physical tense and “occlusive disharmony” bring on disorder of “functional harmony of masticatory system” and undermine “adaptive organism abilities” [3].
Occlusion deformity and anomalies of adults cause facial skull skeleton changes. That leads to overstrain of neck, head and back muscles which can cause chronicle muscles discomfort, headache, pain in face and chest, backache up to lumbosacral area [9]. At presence there is much attention to interdependence of dentoalveolar system and locomotor apparatus condition in many published works [1,8,9,10,11].
Stomatologists-orthodontists don’t always take into consideration the interdependence of disorders of dentoalveolar system and locomotor apparatus on the whole in their everyday practice.
In prosthodontics clinic of Irkutsk State Medical University we examined and took holiatry 92 adult patients aged 18-53, having occlusion anomalies and deformity with complications of TMJ dysfunction. All the patients were detected to have disorders in maxillofacial region in concordance with nosologic form of anomaly or occlusion deformity, and also TMJ dysfunction symptoms were detected. During patients examination standing, disorder of postural pose in space was detected.
Orthodontic treatment was in normalization of central and functional occlusions teeth relations and in improvement of psych emotional patients’ condition. Later teeth rows defects prosthetics were carried out. Devices for teeth rows stabilization and physiological jaw relation, leading to optimal relation of TMJ elements were used during rehabilitation period. Moreover, group of 44 patients was treated with manual therapy.
Manual approaches are practiced in prosthodontics clinic since recently [1,8,10,11]. We used manual therapy methods in holiatry of adults with occlusion anomalies, with complications of TMJ dysfunction. In the case of labored mouth opening before orthodontic treatment was carried out, we used manual techniques for masticatory muscles relaxation.
Masticatory muscles relaxation techniques were used in the cases of psych emotional tension and masticatory muscles hypertension.
After active orthodontic treatment, which was in normalization of occlusive relations, those patients were sent to manual therapy clinic. Osteopathic physicians used methods of craniosacral therapy for diagnostics and correction of cerebral and facial skull regions dysfunction. At the same time treatment of dysfunctions of thoracocervical part of spine, chest, thoracic limbs, lumbar spine, pelvis and inferior limbs were carried out with gentle manual techniques. Visceral techniques were used. At once the patients used retainer. We used only retentional apparatuses with removable constructions for free manual correction process. It was found out that as for manual correction oriented patients there is no need to include elements holding lower jaw in central jaw correlation into retainer construction. Retentional periods were noticed to be 1,5 - 2 shorter for those patients in comparison with retentional periods for patients who were nor treated with manual therapy.
We researched long-term results of treatment of 36 adults orthodontic patients with TMJ dysfunction for 3-7 years.
There were 17 patients treated with dental and orthodontic procedures. 8 of them had symptoms of partial occlusion anomaly relapse. The patients complained on clicks while lower jaw movement, pain appearance in temporomandibular joint area. Tendency of lower jaw displacement to prior position was noticed. The patients stopped using retentional apparatuses prematurely and didn’t visit orthodontists. The rest 9 patients used retainers for 3-4 years.
Results of treatment of patients taken orthodontic and osteopathic holiatry were the most effective. So, 3 of 19 patients had symptoms of partial anomaly relapse. Retentional period of that group of patients lasted 3-6 months. Retentional period of the rest patients was 3-18 months. 12 patients continue taking manual therapy once or twice a year.
In their practice stomatologists of all fields need to know and take into consideration peculiarities of examination and holiatry of patients with occlusion anomalies and deformity with complications of TMJ dysfunction:
1. Occlusion anomalies and deformity can lead to TMJ dysfunction appearance.
2. Occlusion anomalies and deformity correction doesn’t always promote TMJ dysfunction syndrome elimination.
3. TMJ dysfunction syndromes intensity doesn’t depend on occlusion anomalies or deformity severity.
4. The goal of orthodontic treatment is normalization of teeth in central and functional occlusions. That can give the opportunity to get influence on physiological position of lower jaw and on optimization of relation of TMJ elements, improving TMJ function and reducing dysfunction intensity. However, it is not always possible to prevent dysfunction manifestation after orthodontic therapy termination.
5. To achieve the goal it is necessary to improve psych emotional patient’s condition and to take measures to eliminate habit to “clench” teeth, to lessen reaction on stress, so it is more difficult to “hurt yourself”.
6. Before starting orthodontic therapy and in its process in the case of labored mouth opening tomatologists- orthodontist can use simple manual techniques for masticatory muscles relaxation.
7. Devices for teeth rows stabilization and physiological jaw relation, leading to physiological changes of TMJ elements are to be used during rehabilitation period.
8. The best and the most stable results are achieved with patients taken orthodontic and osteopathic holiatry and functional correction treatment of locomotor apparatus in manual therapy clinic.
Table of authorities
1. Bugrovetskaya O. Postural equilibrium and temporal-mandibular joint. Postural imbalance in prosopalgia pathogenesis// Orthodontics, 2006. №3. – 21-26.
2. Vyasmin A. Diagnostics and holiatry of temporal-mandibular joint dysfunction symptom: author's abstract of dissertation of Doctor of Medical Sciences – Irkutsk, 1999. – 227.
3. Gross М., Methews J.D. Occlusion normalization / Translation from English– Moscow: Medicine, 1986. – 287.
4. Dolgalev A. Tactics of individual approach in teeth rows integrity restoration of patients with temporal- mandibular joint dysfunction and masticatory muscles: author's abstract of dissertation of Doctor of Medical Sciences – Stavropol.- 2009. – p - 47.
5. Zabelin A., Sotnikova M. Role of occlusive- articulate disorders of changes of psych emotional status in temporal- mandibular joint dysfunction symptom development // Data of international theoretical and practical conference; fundamental and applied issues of stomatology. St. Petersburg, 10-11 Dec. 2009.
6. Kudryavtseva O. Peculiarities of diagnostics and treatment of patients with dentoalveolar anomalies, complicated with TMJ dysfunction: author's abstract of dissertation of Candidate of Medical Science. St. Petersburg. 2010. – p - 17.
7. Puzin A., Пузин А.М., Vyasmin A. Temporal-mandibular joint pain dysfunction. – M.: Medicine, 2002. – 160.
8. Chervotok A. Functional condicion of locomotor apparatus of patients with occlusion anomalies and deformity; author's abstract of dissertation of Candidate of Medical Science – St. Petersburg, 2009. – 22.
9. Khoroshilkina F. Bearing disorder with occlusion anomalies// Ortodent-Info. - 2000. - №1 - 2. - Pp. 40 – 44.
10. Tsymbalistov A., Loushanskaya T., Hudonogova E., Voytyatskaya I., Chervotok E. Dynamics of stabilometric characteristics at the stage of orthodontic treatment of disto-occlusion of patients with locomotor apparatus disorder. // Orthodontia, 2005. - №3 - pp. 21-24.
11. Yurov V. Manual therapy in restoring treatment of patients with pain syndroms caused by temporal-mandibular joint dysfunction: author's abstract of dissertation of Candidate of Medical Science – Moscow, 2006. - 25.
