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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 pathogenesis 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-

Norwegian Journal of development of the International Science No 47/2020 13 quences of such disorders are a decrease in the vital ca- due to a persistent bad habit of breathing through the pacity of the lungs, impaired respiratory function, mouth. Even after eliminating the cause that prevented blood circulation [6, 22]. the passage of air through the nose, the bad habit of

The habit of sucking and biting the lips is as diffi- breathing through the mouth remains and requires some cult to correct as sucking the fingers. It is expressed in correction by a doctor. Characteristic signs of oral ressucking or biting the lower or upper lip. Often the habit piration: non-closing of the lips, disappearance of negoccurs when the protrusion of the incisors of the upper ative pressure in the oral cavity. Clinically, this manijaw, which contributes to the incorrect location of the fests itself as sagging of the mandible by reducing the lower lip. A sharp nervous overstrain can also serve as tone of the muscles that raise the mandible, double chin, an impetus for a strong bite of the lower lip, up to the indicating the sinking of the tongue, non-closing of the appearance of wounds on it. Under the influence of this lips indicates a loss of tone of the circular muscle of the habit there is a vestibular deviation of the upper inci- mouth, which is narrowing of the upper dentition, most sors, the occurrence of dental-alveolar shortening in the expressed in the area of canines and premolars. Oral anterior part of the upper jaw. Less often, the incisors type of breathing contributes to general disorders in the are bent orally. Often develops distal occlusion or ver- body. Chronic oral breathing develops in people who tical incisal deocclusion, with impaired closure of the endure constant physical activity (professional athletes, front teeth. Occurrence of pain in the temporomandib- dancers, ballerinas). This criterion can be taken into acular joint also causes the habit of biting the lower lip, to count when collecting medical history from the patient keep the lower jaw in a more comfortable position [5, or his parents. With normal nasal breathing and closed 17, 27, 28]. lips, the lateral surfaces of the tongue exert sufficient

Sucking the cheeks or pulling them into the mouth pressure on the upper dentition, and with oral respiraand biting often causes the development of symmetri- tion, the tongue occupies the wrong position and does cally pronounced occlusion disorders. The habit of not maintain the normal shape of the upper dentition. sucking the cheeks is often the result of early loss of The pressure of the buccal muscles on the upper dentitemporary molars. The habit of keeping the tongue be- tion with the mouth half-open causes it to deform. Nartween the rows of teeth can also be observed with a rowing of the upper dentition in the area of the canines shortened or incorrectly attached bridle. Such disorders prevents the normal closing of the dentition. There is a cause the development of desocclusion and concomi- reflex contraction of the posterior bundles of the temtant functional disorders in the maxillofacial area. poralis muscles, the lower jaw is displaced posteriorly, Desocclusion caused by sucking the tongue is different ie distal occlusion develops. If the shape of the upper from disorders caused by sucking a finger or other ob- dentition is not corrected in time, then such a violation jects. It is combined with dentoalveolar shortening on is preserved and fixed, hyperactivity of the muscle bunthe part of both the upper and lower dentitions [8, 13, dles, displaces the lower jaw back. In most patients with 14, 18]. similar occlusal abnormalities, the lower lip is located

Improper swallowing negatively affects the func- between the upper and lower front teeth, and children tion of the muscles of the oral and peri-oral areas, the bite it. In case of nasal breathing disorders, many formation of the dental system, can cause prolongation children have adenoid growths on the posterior wall of of orthodontic treatment and recurrence of dental the pharynx, enlarged palatine-pharyngeal tonsils and anomalies and deformities. Clinical signs of swallow- other types of pathology of the nasopharynx. With this ing include increased activity of facial muscles, espe- violation, the nostrils are usually narrow, the nose is cially the chin and lower lip muscles. If during swal- wide, the lips are not closed, the contours of the chin lowing there is a noticeable push of the tip of the tongue are often double. The position of the tongue in the on the inner surface of the lip and its subsequent pro- mouth is disturbed: its tip is shifted back, the back is trusion, then a diagnosis of swallowing disorders is di- low. The space between the root of the tongue and the agnosed. At the same time, the dentition is separated soft palate increases [1, 3, 19, 29]. and the height of the lower part of the face increases. If Articulation of the tongue with the surrounding you quickly open the patient's lips while swallowing, organs and tissues may be incorrect, which is you can see the characteristic location of the tip of the noticeable at rest and, especially, during pronunciation. tongue between the dentition. The constant anterior po- To identify incorrect speech articulation, the patient is sition of the tongue contributes to the development of asked to say phrases consisting of words with a large occlusion anomalies, often vertical incisal disocclu- number of hissing sounds. The indistinct pronunciation sion. Lips and cheeks become a support for the tongue. of these sounds and the location of the tip of the tongue The infantile way of swallowing can be fixed for many between the dentition indicates improper articulation of years or for life [11, 15, 16, 20, 31]. the tongue with teeth, lips, palate, which is often

Respiratory dysfunction is key in the formation of combined with dysocclusion. The development and distal occlusion. There are three types of breathing: na- functional state of the tongue significantly affect the sal (physiological), oral and mixed (pathological). The development of the dental apparatus, and at the same causes of pathological breathing can be different. First, time the development and function of muscles. the inability to pass air through the nose due to obstruc- Impaired motility of the tongue plays a significant role tion of the nasal passages due to curvature of the nasal in the occurrence of dental anomalies. In children, in septum, the growth of polyps, adenoids, hypertrophy of the process of forming an orthognathic occlusion, with the nasal sinuses, frequent colds, sinusitis, allergic rhi- age, the tone of the muscles of the upper lip decreases, nitis. Second, the inability to breathe through the nose and the tone of the muscles of the tongue increases.

14 Norwegian Journal of development of the International Science No 47/2020 However, normally the tone of the muscles of the upper speech therapy correction [3, 14]. Patients with a hislip always prevails over the tone of the muscles of the tory of distal occlusion have a fairly high recurrence tongue. If there is an inverse relationship, then a distal rate: from 60% in cases with tooth extraction and about occlusion is formed [6, 12, 21, 30]. 75% in clinical situations without tooth extraction [10].

The formation of the distal position of the Recurrence after orthodontic treatment is due to the pemandible is also facilitated by the temporal type of culiarities of occlusal relationships, genetically deterchewing, with the actual masticatory muscles attached mined mismatch in size and shape of the teeth of the to the temporomandibular joint closer than the upper and lower jaws, continued growth of the jaws, masseteric. This anatomical feature leads to an increase myofunctional mismatch due to redistribution of masin the process of chewing, as a result, food is swallowed ticatory muscle tone after orthodontic exercise [11, 22]. in insufficiently crushed form, and the tone of the actual It should be noted that in most cases, several factors masticatory muscles changes [18]. play a role in the development of occlusion anomalies,

The formation of distal occlusion is possible due which mutually determine each other and are thus to slow growth and development of the lower jaw linked into a single pathogenetic chain [13, 15, 24]. caused by trauma, chronic inflammation, congenital Conclusion absence or death of teeth. The formation of distal, cross Analyzing the data of publications of domestic and and deep occlusion is observed in unilateral foreign authors, we can conclude that the timely underdevelopment of the mandible. The reason for the correction of dysfunction of the dentition and development of distal and cross occlusion in temporomandibular joint is of great therapeutic and combination with vertical dysocclusion is bilateral prophylactic value and is one of the main tasks of underdevelopment of the mandible. orthodontic treatment of patients in the period of

There is a certain relationship between dental variable occlusion. The most favorable period for the anomalies and disorders of the musculoskeletal system, correction of functional disorders is the end of there is a high prevalence of dental anomalies and temporary and the beginning of variable occlusion. deformities in children with posture disorders: their Comprehensive treatment at this age is important from frequency is 1.6, and in patients with scoliosis - 2.5 the point of view of prevention of occlusal pathology times higher than in the group almost healthy children, and psychological rehabilitation of children, as well as and increases with increasing degree of scoliosis, and to improve the general condition of the body, balanced there is a direct relationship between their complexity growth and development of the maxillofacial area, and the degree of scoliosis [25]. Also among the improve the prognosis of retention of treatment and important etiological factors should be noted calcium temporomandibular joint dysfunction in elderly and fluoride deficiency in the body, insufficient amount patients. of solid food in the diet, early removal of deciduous teeth, jaw injuries and posture disorders [10, 29]. REFERENCES:

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