A malocclusion is caused by many factors - both dependent on ourselves and our way of life, and beyond our influence. One thing is certain - malocclusion is always worth treating - both in children and adults.
Where do malocclusions come from? Are there any factors that determine whether a person will have a problem with it?
» The masticatory organ is exposed to many damaging factors that they can cause morphological and functional changes in it. Initially, these changes may concern only some parts, and in later periods include the remaining parts of the masticatory organ.
When considering the causes of abnormalities in the area of the face, jaws and teeth, the following should be taken into account: the child's development period, time, strength and mode of action of the damaging factor, tissue affected by this cause, and the body's response to destructive factors. In most cases, malocclusion is caused not by pathological processes, but by moderate disturbances in the course of normal development.
Sometimes the cause of a malocclusion is one specific cause, e.g. underdevelopment of the lower jaw, caused by a childhood fracture or a characteristic malocclusion associated with a given syndrome. Very often, a malocclusion is the result of various factors influencing growth and development, so it is impossible to identify one factor responsible for its formation.
Although it is important to know the stimulus that directly causes the defect, knowing most of the etiological factors, they should all be considered when treatment is started. The division of etiological factors causing disorders in the masticatory organ is presented differently. According to professor Łabiszewsia-Jaruzelska, we divide these factors into internal and extrinsic ones, affecting the embryo and fetus, and extrinsic ones affecting the post-fetal life.
In the latest textbook by professor Karłowska, the causes of the masticatory system abnormalities can be divided into general (heredity, endocrine disorders, systemic diseases), extrinsic (e.g. incorrect position of the fetus or mechanical pressure caused by e.g. a tumor, avitaminosis, harmful effects of drugs) etc.) and local (dysfunctions, parafunctions, caries, injuries).
Facial features are influenced by factorsgenetic. Family resemblance is easy to recognize by the line of the nose, the shape of the jaws or the smile. The Habsburgs' mandible, the prognostic mandible of the German royal family, is a standard example to illustrate how certain parental traits are inherited by their offspring. Congenital factors can work in two ways. First, the inborn disproportion between the size of the teeth and the size of the alveolar process may cause crowding or gaps, and secondly, the disproportion between the size of the maxilla and the mandible may result in abnormal occlusal relations.
Why a correct bite is important and what should it look like?
» Today we can distinguish the concept of the stomatognathic system and the masticatory system - these similar terms cannot, however, be understood in a similar way. The masticatory organ is a group of tissues and organs of the oral cavity that take part in the chewing process, i.e. the intake and grinding of food. The stomatognathic system, on the other hand, is a broader concept, meaning morphological - a functional set of mutually interacting tissues and organs of the oral cavity and the facial part of the skull, which, creating a functional whole controlled by the central nervous system, take part in the act of chewing, swallowing, preliminary digestion, formation of sounds and breathing, and also participate in expressing emotional states. Thus, it is not a morphologically uniform system. It consists of various function-oriented structures, where the individual components interact with each other to form a specific morphological-functional complex, called the stomatognathic system.
The occlusal norm is the dental contacts corresponding to the first class angle "a. Each tooth contacts its counterpart in the maxilla and the previous tooth in the arch, except for the lower medial incisors. Each maxillary tooth contacts its counterpart. in the mandible and the distal standing tooth, except for the last upper molars. From a functional point of view, the correct contact of the incisors is considered to be about 1/3 of the height of the lower incisors in the vertical direction.
What should parents of young children pay attention to - can the bite of milk teeth indicate what a permanent tooth bite will look like. And when should treatment begin?
» From the newborn to early childhood, i.e. 6 - 7 years of age, there are changes related to growth and development, such as shaping the vertical body posture, eruption of the first milk teeth, development of breathing and sucking functions, swallowing then perfecting the camerachild's movement and motor skills, speech development, chewing, swallowing and erupting milk teeth. The period of early childhood is equally long in boys and girls, from 3 to 6-7 years of age, when the first permanent teeth are erupted. The stage, also known as the period of use of the complete deciduous dentition, is also important, in which skeletal growth, changes in the dental arches (transverse growth of the maxilla and mandible) and remodeling of the temporomandibular joints are visible.In the period of early childhood, care for the development of the proper function of the masticatory system and the maintenance of the continuity of the dental arches should be the responsibility of all those who are responsible for the child's he alth. Proper hygiene is particularly important, because non-compliance with it, a diet with a high content of carbohydrates, and lack of vitamins contribute to tooth decay. Caries can result in premature loss of both deciduous and permanent teeth, which leads to a lowering of the occlusal plane and deep pseudo bite. Extensive cavities on the contact surfaces of the posterior teeth damage the contact points, which results in the shortening of the dental arches. If it occurs during the developmental period, it usually disrupts the growth and development of the masticatory organ and leads to dysfunction. Premature loss of deciduous teeth causes shifting of the remaining teeth and loss of space needed for the correct eruption of permanent teeth.
What is the bite treatment process and what does it look like?
» Prevention of bite disorders comes to the fore. Prevention is closely related to the removal of potential causes of occlusion disorders (dysfunctions and parafunctions, nodule wedging, extractions). Maxillofacial orthopedic treatment can be: early, appropriate, late and retention. Early treatment is used in the early stages of a child's development, when the causes are active, and no more serious morphological and functional disorders have occurred. Removal of the cause causes the elimination of the irregularities in the chewing organ that is formed in a short time. Early treatment involves myotherapy, re-education, filing of nodules, an elastic band for the mandible, devices in the form of vestibular plates, space maintainers, and functional appliances.Proper maxillofacial and orthopedic treatment is used in the period of mixed and permanent dentition. The methods mentioned in the early treatment are used, and additionally, active devices in the form of Schwarz plates, functional and functional block devices, as well as fixed devices. Late maxillofacial orthopedic treatment refers to the ending or ending development of a child. During this periodmaxillofacial and dental abnormalities are permanent. Treatment is long, difficult, complicated and is carried out mainly with the use of fixed appliances, often also in cooperation with a surgeon or prosthetist. The final stage of treatment is the so-called retention, consisting in the use of braces maintaining correct bite after previous maxillofacial and orthopedic treatment.
Until recently, braces were associated only with children, but today adults also wear them. Does this mean that teeth straightening can be performed at any age?
» Modern orthodontics is heading towards conservative solutions that allow the maintenance of as many he althy tooth and periodontal tissues as possible. Modern methods of diagnostics (cbct) and treatment (corticotomy, insignia) as well as combining knowledge from various fields of dentistry and general medicine are used in maxillofacial and interdisciplinary management. The number of possibilities offered by the current knowledge in the field of orthodontics allows for the treatment of malocclusion without age restrictions. However, it should be remembered that each maxillo-orthopedic treatment should be preceded by a thorough medical history, physical examination and diagnostics. A treatment plan must be established depending on the type and degree of the disorder. Functional malocclusion requires relatively simple treatment methods, while morphological disorders are difficult and long to treat.
Bibliography:
Children's dentistry, Angus C. Cameron, Richard P. Widmer, 1st Polish edition, edited by Urszula Kaczmarek, Urban & Partner, Wrocław 2005; Maria Szpringer-Nodzak, Magdalena Wochna-Sobańska (eds.): Developmental age dentistry, Warsaw 2003, 4th edition (reprinted 2010), PZWL Medical Publishing; Irena Karłowska (ed.): Outline of modern orthodontics. A textbook for students and dentists, Warsaw 2008, 3rd edition (reprinted 2009), Wydawnicto Lekarskie PZWL
Orthopedics of the jaw. Principles and practice edited by F. Łabiszewska-Jaruzelska, PZWL, 3rd edition, Warsaw 1997, Outline of maxillary orthopedics - orthodontics edited by A.Masztalerz, Warsaw PZWL 1981; Stanisław Majewski: Dental gnathophysiology. Occlusion standards and functions of the stomatognathic system, Warsaw 2007, 1st edition (reprint 2009), PZWL Medical Publishing; Eugeniusz Spiechowicz: Dental prosthetics. A textbook for students of dentistry, Warsaw 2008, VI edition (reprinted 2010), PZWL Medical Publishing House