Child's bite anomalies. Existing types of occlusion and their features What is the name of the pathology of occlusion code

About 90% of the world's population lives with a bite that does not correspond to the norm. Most often, the defects are subtle and do not affect aesthetics, diction, or the ability to chew food properly. But sometimes malocclusions can be serious, affecting the quality of life.

At birth, the baby's lower jaw is always slightly larger than the upper jaw. The process of active sucking and jaw growth correct this asymmetry, but in some cases the anomalies persist, aggravated by various factors:

1. Incorrect selection of nipples for bottles during artificial feeding. If the hole is too large, the child works weakly with the jaw during feeding, so the bite is not corrected naturally.
2. Bad habits in infancy - when the baby does not part with the pacifier, sucks his finger or toys.
3. Frequent or chronic ENT diseases. Due to rhinitis and sinusitis, the child breathes through the mouth, and with the lower jaw constantly open, an abnormal bite is formed.
4. Genetic predisposition, heredity.
5. Early loss of baby teeth or, conversely, delay in their replacement.
6. Diseases affecting bone tissue (rickets), jaw injuries, improper bone fusion.

Recent research data show that malocclusions can form due to incorrect posture, including in overweight people and athletes.

The reasons for the formation of malocclusion in children can be bad habits and heredity.

Types of malocclusions

The main classification of changes in the position of teeth was developed by orthodontist Edward Engle, based on the position of the molars of the upper jaw relative to their antagonists in the lower jaw. According to Engle, there are three types of occlusion:

Neutral, in which the position of the molars is correct, but there are other deviations from the norm. Class I malocclusions are:

• A gap (diastema) between the upper front teeth. Up to 5 years of age, its presence is considered normal, but when permanent lateral incisors appear, the gap should close.
• Crowding of teeth, which occurs if their size is larger than the volume of the dental arches.
• Tremas are cracks that appear when the size of the units is reduced. In the primary occlusion, the presence of three is considered the norm: in this way, the teeth are prepared to be replaced by permanent ones.
• Dystopia: eruption in an atypical place, which occurs due to lack of space in a row, pathologies during pregnancy and childbirth.

With a mesial bite, the lower jaw is pushed forward.

Distal bite– advancement of the upper teeth. The upper incisors may be inclined towards the upper lip or palate. This position of the teeth often causes disturbances in diction and the chewing process, accompanied by

Mesial– opposite to distal: the upper jaw is smaller than the lower jaw. Often there is so-called dentogingival compensation: the upper teeth are characterized by crowding, while on the lower teeth they are located evenly or with threes.

There are other types of pathology:

• , characterized by the inability to close the front teeth. Most often it occurs due to ENT diseases, heredity, endocrine disorders, and bad habits. There are three stages: I degree - an interval of up to 5 mm, II degree. – 5-9 mm, III – more than 9 mm.
• Deep– significant overlap of the bottom row with the top row. There are also three degrees depending on severity.
• Cross– from the name it is clear that antagonistic teeth intersect with each other.

In most cases, defects not only spoil the smile, but change the shape of the face, disrupt important functions (talking, chewing), and therefore require elimination.

In childhood and adolescence, bite correction occurs more easily due to the active formation of the jaw bones.

Devices for correcting bite

When treating children, various types of functional appliances are selected that are designed to correct the incorrect position of teeth. We list the popular and effective ones:

1. Braces– a popular, frequently encountered design, which will be discussed in detail below.
2. Trainers– silicone products intended for children: soft (up to 8 years) and hard (8-12 years). They do not require constant wearing: two hours a day is enough, during which it is forbidden to eat or talk.
3. Mouth guards– unique “covers” made of transparent materials, recommended for correcting malocclusion in patients over 14 years of age. The treatment uses several custom-made trays, the shape and size of which change depending on the movement of the teeth.
4. Records They consist of a plastic base located on the palate and metal arches attached to the teeth and leveling their position. The use of plates is advisable during the period of active growth of the dental system - up to 12 years.

In addition to braces, special plates are used to straighten teeth in children.

Bracket systems

Braces are non-removable structures with locks and an arch fixed in them that puts pressure on the teeth. There are several types of bracket systems:

• Metal– durable, eliminating defects faster than others, but unaesthetic.
• Plastic– do not differ in color from enamel, so they look aesthetically pleasing, but are fragile and can be stained by food and drinks.
• Ceramic– stronger than plastic ones, but it takes longer to heal compared to metal ones.
• Sapphire- invisible, aesthetic, but quite expensive.

There are lingual braces that are fixed on the back of the teeth. They are invisible to others, but wearing them is not always convenient - problems with diction and irritation of the tongue appear.

Braces are placed only on permanent units, and therefore are used to eliminate malocclusion pathologies in adults and children over 11 years of age. long-term – up to 2 years under medical supervision.

Metal braces are a reliable and affordable option for correcting malocclusion.

Preventative designs

The main rule of prevention is to wean the child from bad habits and promptly consult a doctor if deviations occur. In addition, there are special preventive structures that can be used to prevent the formation of malocclusion. They are intended for children under 2 years old, and their shape resembles a pacifier:

1. Stoppi– silicone models that prevent pressure on the upper teeth.
2. Muppy— several types of products that solve different problems: accelerating the growth of the lower jaw, accurately closing the lips, enhancing the work of the orbicularis muscle, and others.

Vestibular plates do not require constant wearing; It is enough to use them twice a day for 15 minutes.

Stoppi is a special device for the prevention of malocclusion in children under 2 years of age.

Surgical methods

If the defect is pronounced, surgery may be performed. Indications for it are:

• diction disorders;
• erasing enamel;
• inability to close the lips completely;
• tooth decay;
• difficulty swallowing caused by the position of the tongue between the rows of teeth;
• diseases of the digestive system due to insufficient chewing of food.

The operation follows the following algorithm:

1. 1. Introduction of general anesthesia.
   2. Dissection of bone tissue.
   3. Rearranging the bone in the required direction (horizontal or vertical plane), fixing it with screws and plates.
   4. Applying a splint, fixing the chin with a tight bandage.

The recovery period after surgery is difficult, since it is difficult for the patient to talk, and he only has to eat liquid food with the help of a straw. In order not to waste time and correct violations in a timely manner, you should come to an appointment with an orthodontist with a child aged 6-7 years, even if there is no visual malocclusion.

Sources:

1. Khoroshilkina F.Ya. Guide to Orthodontics. Moscow, 1999.
2. Persin L.V. Orthodontics. Treatment of dental anomalies. Moscow, 1998.
3. Official websites of vestibular plate manufacturers.

Correct bite is the normal physiological formation of the jaw and the growth of teeth, during which a person does not experience any problems.

With an incorrect bite, the teeth are incorrectly positioned, which causes problems both with the teeth themselves and with internal organs: the digestive system due to poorly chewed food, breathing and speech.

Doctors believe that malocclusion is quite common, but in most cases the violations do not go beyond the established norms and do not cause problems. In this case, the patient does not require treatment. If improperly grown teeth have led to a number of problems, they must be eliminated.

It is important to know: Treatment for malocclusion depends on the specific situation.

Depending on the severity of the situation, different options may be offered: braces, special plates, simulators for jaw development, and even surgery.

Kinds

Malocclusions can be associated with the upper and lower jaws. They are divided into the following types:

1. Distal: associated with a highly developed upper jaw and an underdeveloped lower jaw - the upper teeth move forward strongly.
2. Mesial: is the opposite of a distal bite, in which an overdeveloped lower jaw moves forward.
3. Deep: observed in cases where the upper teeth overlap the lower teeth by more than half.
4. Open: the teeth do not close completely; when the mouth is closed, there is a gap between the rows.
5. Cross: characterized by weak development of one of the sides.
6. Dystopia: with this anomaly, the problem lies in the location of the teeth; they grow out of place.
7. Diastema: These are gaps between adjacent teeth, most often found between the upper incisors.

There are 3 degrees of anomalies:

1. at grade 1, the difference between correct and incorrect bites is no more than 5 mm;
2. for grade 2 – no more than 9 mm;
3. at grade 3 – more than 10 mm.

Any anomaly leads to the following problems:

1. With the teeth and jaws themselves: with close contact, the teeth quickly wear against each other, and there is also a risk of wounds and inflammation due to teeth touching the gums and difficulty in dental treatment.
2. With breathing, swallowing and chewing: a person is not limited in this, but does it incorrectly from a physiological point of view. In turn, this often becomes the cause of the development of diseases of internal organs.
3. With serious stress on the jaws and the temporal lobe of the skull, which can cause constant headaches.
4. With speech: a person may speak unclearly, crumpled, or have a lisp, but the help of a speech therapist will be powerless.
5. Appearance and self-esteem: A misaligned jaw may cause the face to take on an angry expression or appear too long.

Causes and treatment

Problems with bite can often be observed already in childhood: due to incorrect or uneven development of the jaw in children, teeth begin to grow differently than they should. Despite the large number of types of anomalies, the reasons most often turn out to be the same:

1. Heredity, that is, malocclusion is congenital, illness or injury suffered by the mother during pregnancy.
2. Bad habits of babies: sucking a pacifier or finger, lack of solid food, that is, the lack of a “simulator” for the jaws.
3. Bone-related diseases or jaw injuries, improperly fused bones.
4. Disturbances in breathing, chewing and other functions, abrasion of teeth.
5. Too early or late loss of baby teeth.
6. Poor environment, lack of vitamins, problems in child development.

Note: In some cases, the cause of malocclusion may be that the upper frenulum is too low.

Treatment is most effective in childhood, during the first growth of teeth and the replacement of milk teeth with molars. In early childhood, to prevent development, it is enough to wean the child from bad habits, regularly give solid vegetables and fruits, and also monitor the growth of teeth.

When changing teeth, you will need to perform special exercises and wear removable braces, which help to “move” the teeth and straighten the jaw. If the problem is not corrected immediately, it will be much more difficult to do in adulthood: it will take several years of wearing rigid structures, and in especially difficult cases, surgery.

During the latter, the patient’s jaw is “removed” and placed in the correct position, secured with special systems. After healing, the bite is completely corrected.

An incorrect bite not only looks unsightly, but can also cause health problems. It is necessary to closely monitor the development of teeth in children and use a set of devices to prevent malocclusions, and, if necessary, carry out more serious treatment.

For information on all malocclusions, watch the following video:

Bite – the relationship of the dentition in the position of central occlusion.

Central occlusion – type of closure of the dentition with the maximum number of contacts of antagonist teeth. The head of the lower jaw is located at the base of the slope of the articular tubercle, and the muscles that bring the lower row of teeth into contact with the upper row (temporal, chewing and medial pterygoid) are simultaneously and evenly contracted.

The nature of the closure of the dentition depends on the number, size, position of the teeth in the dentition, the morphology of the dental arches, as well as on the size, shape of the jaw bones and their location in the bones of the skull.

Distinguish physiological and pathological bite . The differences are based on morphological and functional characteristics. The morphological characteristics of each bite are based on an assessment of the nature of the closure of functionally oriented groups of teeth: molars and anterior group.

Physiological bites include: orthognathic, direct, biprognathic, physiological progenic.

Classifications of developmental anomalies and deformations of the jaws and teeth

Classification according to D.A. Kalvelis:

I. Anomalies of individual teeth

II. Anomalies of the dentition

III. Malocclusions

Classification according to V.Yu. Kurlyandsky:

Excessive development of both jaws, upper (prognathia) and lower (progenia)

Underdevelopment of both jaws, upper (micrognathia) and lower (microgenia).

Clinical and morphological classification of developmental anomalies and deformations of the jaws and teeth:

I. Anomalies of teeth.

Anomalies of shape, size, number, timing of eruption, position in the dentition, structure of hard tissues.

II. Anomalies of development and deformation of the dentition.

Violation of shape and size in the sagittal, vertical and transversal directions; symmetry of the arrangement of teeth on the right and left sides; contacts between adjacent teeth.

III. Anomalies of development and deformation of the jaws and their anatomical parts.

Violation of shape and size in the sagittal, vertical and transversal directions; the relative position of the anatomical parts of the jaw relative to each other; position of the jaws in relation to the base of the skull.

IV. Bite abnormalities.

Malocclusion in the sagittal direction (prognathic, progenic); in the vertical direction (open, deep); in the transversal direction (laterognathic, laterogenic). Combined bite pathology in two or three directions.

Morphological characteristics of physiological permanent dentition:

1) number of teeth – 32;

2) all the teeth of the upper and lower jaws are in contact with each other so that each tooth intersects with two antagonists (except for the upper third molar and the first lower incisor). The upper tooth is in contact with the lower teeth of the same name and behind it; each lower one has the same name and the one in front of the upper teeth;

3) the midline of the face runs along the lines between the central incisors of the upper and lower jaws and is in the same sagittal plane with them;

4) the dentition does not have spaces between the teeth;

5) the dentition has a certain shape: the upper one is a semi-ellipse, the lower one is a parabola;

6) the upper dental arch is larger than the lower one, while its extra-alveolar part is larger than the intra-alveolar part due to the inclination of the teeth vestibular. The extraalveolar part of the lower arch is smaller than the intraalveolar part due to the inclination of the teeth in the oral direction;

7) the buccal tubercles of the upper lateral teeth are located outward from the same tubercles of the lower teeth. Thanks to this, the palatal tubercles of the upper teeth are located in the fissures of the lower teeth;

8) the head of the lower jaw is located on the posterior slope of the articular tubercle.

Morphological characteristics of the physiological occlusion of primary teeth:

1) number of teeth – 20;

2) dental arches have the shape of a semicircle, the upper dental arch is larger than the lower one;

3) the midline of the face passes between the upper and lower central incisors;

4) the teeth in the dentition are located tightly, without gaps;

5) the upper first molar closes with the lower molar of the same name and the posterior one, the contact of the teeth is fissure-tubercular;

6) the upper incisors overlap the lower ones by no more than 1/3 of the tooth crown.

By the age of 5, abrasion of the chewing surfaces of all teeth develops (should occur evenly on all teeth), physiological trema and diastemas appear between the milk teeth, indicating the longitudinal growth of the jaw bones and the preparation of the dental arches for the eruption of permanent teeth. The bite is straight.

Orthognathic occlusion refers to the most anatomically and functionally perfect form of closure of the dentition. In modern humans, it is the most common occlusion.

Orthognathic permanent dentition is characterized by all the signs of physiological occlusion. The upper front teeth overlap the lower ones by about 1/3 of the crown.

Direct and biprognathic bites differ from orthognathic bites in the closure of the front teeth. With direct bite The front teeth meet at the cutting edges. With biprognathic occlusion the anterior teeth of the upper and lower jaws are inclined forward, but at the same time the cutting-tubercle contact is maintained between them. Physiological progenic bite see in progenic occlusion.

Anatomical and functional characteristics of pathological occlusion:

Diagnosis of pathological occlusion is based on comparison of morphological deviations from normal anatomy in the structure of the jaws and teeth, assessment of the degree of functional disorders in groups of various muscles (masticatory, facial, tongue, soft palate, pharynx) and disorders of the temporomandibular joint.

The morphological characteristics of pathological occlusion are created by assessing the type of closure of the dentition according to the anatomical and functional groups of teeth: the type of closure of molars and anterior groups of teeth on both sides of the jaws. Types of malocclusion are usually considered in three directions: sagittal (forward, backward), vertical (up or down from the occlusal plane), transversal (lateral, medial).

Prognathic occlusion

A prognathic occlusion is a relationship of dentition in the central closure in which the upper dentition in relation to the lower one is displaced anteriorly or the lower dentition in relation to the upper one is displaced posteriorly completely or partially. Partial displacement may affect the frontal areas of the dentition or one of the lateral ones (right or left).

The causes of prognathic occlusion can be: a congenital structural feature of the facial skeleton, childhood diseases that affect the development of the skeletal system, improperly organized artificial feeding of the child, inflammatory processes in the nasopharynx, early loss of primary molars, bad habits.

The distal jaw relationship in newborns is a physiological pattern. The functional load on the lower jaw during sucking promotes its rapid growth, and after the eruption of temporary teeth, the jaw relationship is normalized. If artificial feeding is incorrect or for some other reason, the growth of the lower jaw may be delayed. Functional disorders resulting from increased tension of the cheek muscles, weakening of the orbicularis oris and masticatory muscles contribute to the distal position of the mandible. Failure to close the lips due to oral breathing or bad habits leads to disruption of the synergism and antagonism of the muscles of the perioral area, which is clinically manifested in lip deformation: the upper lip is raised and shortened. Deviation of the nasal septum, hypertrophy of the inferior turbinates, enlargement of the velopharyngeal tonsils, polyps, adenoids, and other chronic diseases of the upper respiratory tract are a mechanical obstacle to nasal breathing. As a result of not closing the lips and mouth breathing, the tightness of the oral cavity is broken, the negative pressure in it disappears, the tongue does not fill the dome of the palate, but sinks to the bottom of the oral cavity. All these disorders lead to a narrowing of the upper dentition, which secures the distal position of the lower jaw. The narrowing of the upper dentition reduces the transverse size of the upper jaw, which is also facilitated by the tension of the cheek muscles. As a result, the depth of the palate increases, the volume of the nasal cavity decreases, and the nasal septum becomes even more bent, which aggravates existing disorders. Due to the discrepancy between the sizes of the dental arches in the sagittal direction, the lower lip fills the gap between the upper and lower frontal teeth. Under its pressure, the upper incisors deviate vestibularly, the lower ones - orally, which aggravates the violation of lip closure and their shape.

Prognathic occlusion has characteristic clinical symptoms. Facial characteristics: the upper central teeth are not covered by the upper lip, the upper incisors are elongated and bite the lower lip, the upper lip is shortened and thickened, the mouth is open. If nasal breathing is impaired - collapsed nostrils, wide bridge of the nose. Incorrect tongue position is manifested by the presence of a double chin. In severe cases, the profile of the “bird” face is a strongly sloping posterior chin.

Oral symptoms: absence of incisal-tubercle contact of the incisors - presence of a sagittal fissure; the teeth of the lateral segments (canines, premolars, molars) of the upper jaw are in tubercular contacts or are located in front of the lower teeth of the same name.

Functional disorders are associated with a decrease in the area of ​​functioning chewing surfaces of the teeth, which leads to deterioration in chewing. Lack of contact between the incisors can cause difficulty biting food. Mouth breathing and infantile swallowing aggravate morphological disorders. Speech disorders can result in unclear pronunciation of sounds.

There are different types of prognathic occlusion: dental, dentoalveolar, gnathic and cranial.

Dental and dentoalveolar forms of prognathic occlusion can be explained by significant differences in the size of the dental arches - lengthening of the upper dentition or shortening of the lower dentition. Lengthening of the upper dentition may be a consequence of an increase in the size of the upper teeth in relation to the lower ones, or the presence of supernumerary teeth in the upper dentition. Shortening of the lower dentition may be a consequence of premature loss of primary teeth.

Gnathic forms of prognathic occlusion can be the result of underdevelopment of the body or branches of the lower jaw (lower micrognathia), a decrease in the size of the mandibular angles, or excessive development of the upper jaw (upper macrognathia). The causes may be disturbances in the growth of the lower jaw of an inflammatory or traumatic nature or differences in the growth rate of the jaw bones.

A picture similar in clinical manifestations to gnathic forms of prognathic occlusion occurs in cranial forms. These forms include retrognathia lower - the posterior position of the lower jaw together with the joints in relation to the upper and to the base of the skull and prognathia upper - the anterior position of the upper jaw relative to the lower jaw and the base of the skull.

Progenic bite

Progenic occlusion refers to sagittal malocclusion and is characterized by a displacement of the lower dentition in central occlusion anteriorly in relation to the upper or upper dentition in relation to the lower - posteriorly, completely or partially. In the literature, other terms are used to characterize this type of pathological occlusion: mesial occlusion, progeny, anterior occlusion, etc.

A progenic bite determines the external similarity of patients: the chin protrudes forward, the upper lip sinks, and the facial profile is concave. The severity of these external signs depends on the degree of morphological and functional disorders. The basis for differential morphological diagnosis is the dental, dentoalveolar, gnathic and cranial varieties of progenic occlusion. Each of these forms can be combined with a displacement of the lower jaw.

The “false” or “frontal” type of progenic bite is characterized by reverse frontal overlap of the incisors. In the lateral parts of the dentition, correct occlusal relationships are usually maintained. The reasons for this form may be displacement of the rudiments of the upper frontal teeth due to trauma or inflammatory diseases in the area of ​​the apexes of the roots of temporary teeth, delayed resorption of the roots of temporary frontal teeth, an increase in the frontal lower segment (supernumerary teeth, three spaces between teeth), a decrease in the upper frontal segment (congenital absence of one or both second upper teeth or an anomaly in their shape). Vestibular inclination of the lower frontal teeth with the presence of three between them can be caused by bad habits of sucking or biting the upper lip, tongue, fingers, and foreign objects.

Gnathic forms of progenic occlusion may be a consequence of underdevelopment of the upper jaw or excessive growth of the lower jaw. The large size of the lower jaw may be a congenital feature of the structure of the bones of the facial part of the skull, which is inherited. In this case it occurs physiological progenic bite, which is characterized by multiple contacts between the dentition in the anterior and lateral areas. This occlusion is an anatomical variant that is not subject to orthodontic treatment. The causes of enlargement of the lower jaw, accompanied by a pathological progenic bite, can be: shortened or incorrectly attached frenulum of the tongue, macroglossia, hypertrophy of the velopharyngeal tonsils, mouth breathing, hyperfunction of the pituitary gland in adolescence and its consequence – acromegaly. In the listed cases, the leading factor in the pathogenesis of enlargement of the lower jaw is excessive pressure on it from the tongue (large, with an increase in its size; does not rise to the vault of the palate when the frenulum is shortened; moves anteriorly when the tonsils enlarge). Explaining the pathogenesis, we can talk about reactive lower macrognathia. Macrognathia mandibular can be the result of an enlargement of the body of the mandible, its branches, an increase in the mandibular angles, or a combination of these disorders.

Underdevelopment of the upper jaw can be associated with multiple congenital hypodontia in the upper jaw, multiple retention of the upper teeth or their early loss, a chronic inflammatory process (for example, osteomyelitis) of the upper jaw during its growth, congenital clefts of the alveolar process and the upper jaw. The listed reasons can interfere with appositional or sutural growth of the upper jaw. In the clinic of gnathic forms, the common symptoms for all types of progenic occlusion include: lengthening of the lower part of the face, tense closing of the lips or gaping of the mouth, dentoalveolar lengthening of the anterior sections of the dental arches, difficulty biting and chewing food, lisp of speech. As a result of improper chewing load, the following are observed: deposition of tartar on the lower front teeth, damage to them by caries, gingivitis, and periodontal disease.

The cranial form of progenic bite is caused by genetic or congenital structural features of the bones of the facial part of the skull. The upper jaw can have a posterior position in the space of the head skeleton with its normal size, just as the lower jaw can have an anterior position. It is impossible to exclude the possibility of the appearance of cranial forms of progenic occlusion during the growth of a child due to childhood diseases, calcium metabolism disorders as a result of rickets or other diseases.

Progenic occlusion can be observed at different age periods. The distance of the gingival ridge of the lower jaw in relation to the gingival ridge of the upper jaw indicates the possible formation of a progenic bite during the eruption of primary teeth. The progenic relationship of dentition occurs during the period of temporary, mixed and permanent dentition.

Open bite

Open bite refers to vertical malocclusion and is characterized by the presence of a vertical gap between the teeth when the dentitions are closed. Such a gap can be in the frontal area or in the lateral areas, or in both.

YES. Kalvelis (1964) distinguishes two forms of open bite by origin: true, or rachitic, and false, or traumatic.

The cause of a traumatic open bite is the excessive vertical load that individual teeth or groups of teeth experience during the formation of occlusion. Sucking fingers, tongue, lips, cheeks, pencils and various objects can cause a traumatic open bite. The pathogenesis of this type of malocclusion involves dentoalveolar shortening in areas of the dentition that experience increased load. In this case, the gap between the teeth corresponds to the shape of the object that the child is sucking. The lateral teeth (if there is a source of chronic trauma between the dentition) do not close. This leads to dentoalveolar elongation in the lateral areas, increases the height of the lower part of the face, and aggravates the clinical manifestations of the disease. The source of increased pressure on certain areas of the dentition may be the tongue. An open bite develops with the infantile type of swallowing, when the child pushes away from the closed lips with the tip of the tongue. It is believed that the size and shape of the tongue during the embryonic development of the oral cavity can predetermine the formation of an open bite. The size of the tongue and the laxity of the tongue muscles determine its incorrect position at rest (interincisal position of the tip or interocclusal position of the lateral sections of the tongue), which causes under-eruption of teeth in the corresponding areas. Incorrect position of the tongue at rest and function may be due to a shortened frenulum, enlargement of the velopharyngeal tonsils, the habit of inserting the tongue into a defect in the dentition after early loss of temporary or permanent teeth, incorrect articulation of the tongue when pronouncing speech sounds in the manner of close relatives. Difficulty in nasal breathing, forcing the child to keep his mouth open, or the habit of mouth breathing may be a factor.

The listed reasons in classical pathogenesis cause dentoalveolar forms of open bite.

Gnathic forms of open bite are caused by impaired growth of the jaw bones in conditions of impaired calcium metabolism due to rickets, infectious, somatic diseases, and endocrine disorders. The shape of the upper and lower jaws changes under the influence of the traction of the muscles, primarily the chewing muscles. The dentoalveolar and basal arches of the upper jaw, under the pressure of the masticatory muscles themselves, narrow in the lateral sections and elongate in the anterior. The narrowing of the basal part of the upper jaw leads to deformation of the vault of the palate, the bottom of the nasal cavity, and disruption of the development of the paranasal sinuses. The movable lower jaw is deformed even more significantly, mainly under the influence of the traction of the masticatory muscles themselves and the muscles that lower the lower jaw. Along the lower edge of the body of the lower jaw, in front of the attachment of the masticatory muscles themselves, a depression is formed, the branches are shortened and bent, and the angles increase. The relative position of the upper and lower jaws in the space of the skull changes, the interalveolar height in the distal parts decreases due to dentoalveolar lengthening in the lateral parts of the upper jaw, the roots of the teeth and alveolar processes in the anterior section of the dental arches are shortened. These skeletal changes are aggravated by the vertical direction of jaw growth.

The causes of gnathic forms of open bite can also be disturbances in the growth of the upper jaw due to congenital cleft of the alveolar process and palate, traumatic injuries of the jaws, temporomandibular joints, and cancer.

Cranial forms of open bite are caused by the peculiarities of the development and growth of the skull bones with unfavorable heredity.

An open bite can occur in periods of temporary, mixed and permanent dentition. It can be observed with a neutral relationship of the dentition or complicate sagittal and transversal malocclusions. The severity of the anomalies is determined by the size of the vertical gap and the number of teeth that are not in contact with the occlusion. There are three degrees of severity of open bite: I degree - vertical gap up to 5 mm; II degree – from 5 to 9 mm; III degree – more than 9 mm.

The severity of clinical symptoms depends on the severity of the malocclusion. The lips do not close or close with tension, the tongue is located between the teeth and is visible when the lips are not closed, the lower part of the face lengthens. Gingivitis develops in the area of ​​the upper and lower frontal teeth, and there may be dental deposits. The tongue is usually enlarged, it may have longitudinal and transverse grooves, and the shape of the bony palate is changed. Often there is a close arrangement of teeth.

An open bite is accompanied by severe functional impairment. Difficulty biting food, chewing, swallowing. Incorrect articulation of the tongue is often accompanied by dyslalia. Breathing through the mouth causes dry mucous membranes and increases susceptibility to respiratory infections. Changes in the functional load on groups of teeth lead to periodontal diseases.

Deep bite

Deep bite refers to vertical malocclusion. Anomalies of this type are characterized by displacements of individual groups of teeth in the vertical direction - in height. An initial idea of ​​a deep bite can be obtained by assessing the overlap of the lower anterior teeth with the upper ones. An incisal overlap equal to 1/3 of the height of the crowns of the lower incisors is considered normal. Consequently, a deep bite can be called such a relationship of dentition in central occlusion, in which the lower frontal teeth overlap the upper ones by more than 1/3 of the height of their crown. In this case, the contact between the front teeth of the upper and lower jaws can be maintained, or the incisors of one jaw lose contact with the incisors of the other, and when the dentitions close, they rest against the mucous membrane of the gums or alveolar process of the opposite jaw.

B.N. Bynin (1951) distinguishes between deep bite and deep frontal overlap. With deep frontal overlap, the cutting edges of the lower incisors articulate with the dental cusps of the upper incisors. A deep bite is characterized by closure of the teeth, in which the lower incisors lose their support and slide towards the gingival margin. Deep frontal overlap should be considered as a family feature; the functions of the dental system are not impaired. However, this is an unstable condition, which, in the case of loss of lateral teeth or even destruction of their proximal surfaces by caries, can acquire signs of deep bite.

Deep bite rarely occurs in isolation with a neutral relationship of the lateral teeth. More often it is combined with anomalies in the position of the teeth, deformation of the dental arches, malocclusion in the sagittal and, less often, transversal directions. Causes of the dentoalveolar form of deep bite: carious damage to the hard tissues of the teeth, early loss of the first permanent molars and other lateral teeth. In the pathogenesis of deep bite, the main role is played by the dentoalveolar elongation of the frontal parts of the dentition, which occurs as a result of a change in the position of the anterior teeth and loss of their support. In the absence of treatment with age, the temporomandibular joint is involved in the pathogenetic process. Temporomandibular joint dysfunction is defined as an occlusal-articulatory dysfunctional syndrome, the symptoms of which are pain, crunching, clicking in the joint, facial pain, fatigue of the masticatory muscles, muscle pain, a feeling of fullness in the ears, decreased hearing, headache, dizziness, and sometimes glossalgia , paresthesia, dry mouth. The listed symptoms are explained by the following scheme of development of the pathological process: the absence of occlusal contacts in the anterior region leads to functional overload of the lateral teeth, which may be the cause of the so-called “declining” bite. In intact dentition, with central closure, the articular heads are located at the base of the slope of the articular tubercle. From this position they can move forward, down and to the side. Their distal displacement is limited by occlusal contacts. With a decreasing bite, the articular heads gradually shift distally. The degree of this displacement depends on the degree of reduction in the height of the bite. The distally displaced articular heads put pressure on new areas of the articular fossa, the tissues of which are not physiologically adapted to perceive high pressure. As a result, deformation of the joint elements occurs. Clicking in the joint occurs due to compression, pinching of the articular disc. The distal displacement of the articular heads compresses the blood vessels and nerves in the area of ​​the Glaser (petrostympanic) fissure, which enhances the degenerative processes in the temporomandibular joint.

The reasons for changes in the position of the front teeth may be bad habits of sucking and biting, dysfunction of breathing, swallowing, and speech; enlargement of one dentition with supernumerary teeth, diastema, retained primary teeth, individual discrepancy between the sizes of the upper and lower teeth; reduction of one of the dentitions due to tooth retention (usually second lower premolars) or hypodentia.

The causes of gnathic forms of deep bite may be an increase in the size of the mandibular angles and the anterior position of the upper jaw.

With a neutral relationship between the dental arches, a dentoalveolar form of deep bite is usually observed; with prognathic and progenic, both dentoalveolar and gnathic.

Clinical manifestations of deep bite depend on its combination with neutral, prognathic or progenic. Facial signs are manifested by a decrease in the height of the lower third of the face, deepening of the supramental groove and disturbances characteristic of the sagittal anomaly that accompanies the symptom of “deep bite”. Changes in the shape of the dentition depend on the type of bite. With a neutral occlusion, the dental arches are often flattened in the frontal region, and the anterior teeth are often closely spaced. The lower front teeth are in contact with the mucous membrane of the hard palate. The upper front teeth sometimes injure the interdental gingival papillae on the vestibular side of the lower teeth.

The depth of incisal overlap is judged by the degree of overlap of the crowns of the lower incisors with the upper ones: the first degree of overlap - up to 2/3 of the height of the crowns; second degree – 3/3; the third – more than 3/3.

Functional disorders with deep bite symptoms are expressed in a decrease in the efficiency of chewing, overload of the periodontal teeth, injury to the mucous membrane, and pathological abrasion of the incisors and lateral teeth. Mouth breathing, infantile type of swallowing and incorrect articulation of the tongue, low position of its back at rest cause a narrowing of the dental arches, which aggravates the depth of overlap. There are disturbances in the masticatory muscles in the form of asymmetry in their contraction or increased tone. In the latter case, there is no rest position for the lower jaw with interocclusal space at an average norm of 2 mm. The teeth are constantly closed in central occlusion, the muscles are tense.

Crossbite

Crossbite refers to transversal anomalies of occlusion and is characterized by disturbances in the closure of the dentition in the frontal plane. This anomaly is caused by a change in the size of the dentition (narrowing or expansion of the upper or lower dentition) or a displacement of the lower jaw to the side (forced occlusion). Crossbite can be unilateral or bilateral, symmetrical or asymmetrical.

There are three types of crossbite: dentoalveolar (due to narrowing or widening of the dentoalveolar arch on one jaw or on both jaws); gnathic – due to narrowing or widening of the base of the jaw (underdevelopment or excessive development of one of the jaw bones); articular - caused by displacement of the lower jaw to the side. The displacement of the lower jaw can be parallel to the frontal plane or diagonal. More often than other forms, crossbite is associated with a lateral displacement of the lower jaw.

If the dental arch of the upper jaw is displaced laterally, the bite is called laterognathic; if the lower dental arch is displaced laterally, it is called laterogenic.

In the case of proportional development of the dental arches in the same patient, laterognathic and laterogenic occlusion can be observed. So, for example, if the lower dentition is shifted to the right, then there will be a laterogenic bite on the right, and a laterognathic bite on the left.

The causes of dentoalveolar forms of crossbite can be: atypical location of the primordia of permanent teeth or their retention, delayed replacement of temporary teeth, violations of the sequence of teething, early destruction and loss of temporary molars. Gnathic forms of crossbite develop as a result of impaired growth of the jaw, most often the lower jaw due to diseases of the temporomandibular joint (trauma, including birth, inflammatory processes in the joint, ankylosis, hemiatrophy of the face). Asymmetrical displacement of the lower jaw develops when the child is in an incorrect position during sleep, has bad habits, uneven wear of the cusps of temporary teeth, uneven contacts of the dentition in articulation, uncoordinated activity of the masticatory muscles, etc.

The clinical picture of each type of crossbite has its own characteristics. Often, with a crossbite, the shape of the face is disturbed, and transversal movements of the lower jaw are difficult. Patients often complain of biting the mucous membrane of the cheeks, tongue, and incorrect pronunciation of speech sounds. Crossbite due to traumatic occlusion is accompanied by periodontal diseases, and an anomaly with a displacement of the lower jaw to the side leads to dysfunction of the temporomandibular joints.

Diagnosis of pathological bites

The diagnosis is established on the basis of clinical examination and study of diagnostic models of the jaws, facial photographs (facial profile assessment), data from radiological research methods (orthopantomography, lateral and direct teleroentgenograms of the head, tomography of the temporomandibular joints), craniometric data, electromyography data of masticatory and facial muscles , as well as X-ray CT data with the production in complex cases for calculating the treatment of stereolithographic models.

Treatment of malocclusions

The main method of treatment for malocclusion pathology is orthodontic (use of various devices, braces). If it is impossible to eliminate the anomaly conservatively, treatment is carried out in combination, i.e. The orthodontic method is combined with the surgical one.

Test control

Caries is (install the correct sequence)

Iat which occurs

II with subsequent formation of a defect in the form of a cavity

III pathological process of hard dental tissues

IVappearing after teething

Demineralization and proteolysis

VIunder the influence of unfavorable external and internal factors

The cavity with superficial caries is localized within

enamel and dentin

3. The cavity with average caries is localized within

enamel and dentin

4. Stages of caries treatment (establish the correct sequence)

I finishing the filling

II preparation of carious cavity

III application of an insulating gasket

IV drug treatment

Application of a permanent filling

VIdrying the cavity

5. Acute pulpitis (indicate the numbers of all correct answers)

apical

focal

hypertrophic

fibrous

diffuse

6. Chronic pulpitis (indicate the numbers of all correct answers)

focal

fibrous

diffuse

hypertrophic

gangrenous

granulating

7. Temperature test for acute forms of pulpitis

sharply painful

painful

painless

Complaints with acute pulpitis

constant spontaneous pain not related to the time of day

spontaneous, periodic, predominantly night pain

9. Clinic for acute periodontitis (indicate the numbers of all correct answers)

constant spontaneous pain

pain from temperature stimuli

enlargement of regional lymph nodes

increased pain when biting on a tooth

pain on palpation along the transitional fold in the area of ​​projection of the root apex

Match:

Answer: 1_____, 2_____, 3_____, 4_____.

11. Causes of acute mechanical injury to the oral mucosa (indicate the numbers of all correct answers)

accidental biting

injury with a sharp object

poor quality prosthetics

overhanging edge of the filling

12. Causes of chronic mechanical trauma of the oral mucosa (indicate the numbers of all correct answers)

accidental biting

injury with a sharp object

poor quality prosthetics

long-term irritation from sharp edges of teeth

overhanging edge of the filling

habitual biting of cheeks and lips

Bednar's aftas are found at

children in the first months of life

children 2-3 years old

school age children

teenagers

adults

The success of treatment of traumatic erosions and decubital ulcers determines

choice of painkillers

elimination of factors that injure the mucous membrane

use of certain disinfectants

the use of certain keratoplasty agents

Fungal diseases of the oral cavity include

acute herpetic stomatitis

candidiasis (thrush in children)

shingles

Infectious-allergic diseases of the oral cavity include

chronic recurrent aphthous stomatitis

acute herpetic stomatitis

candidiasis (thrush in children)

Vincent's ulcerative necrotizing stomatitis

shingles

17. Causes of chronic recurrent aphthous stomatitis (indicate the numbers of all correct answers)

hypothermia

diseases of the gastrointestinal tract

suffered from ARVI

bacterial infection

viral infection

18. Activities carried out during the period of remission of chronic recurrent aphthous stomatitis (indicate the numbers of all correct answers)

antibiotic therapy

oral sanitation

oral hygiene training

rinsing the mouth with antiseptic solutions

examination by a gastroenterologist

identification and elimination of foci of chronic infection

examination by an allergist

The causative agent of acute herpetic stomatitis

Fusospirochetes

herpes simplex virus

varicella zoster virus

influenza virus

coxsackie virus

The main element of damage in AHS

The order of eruption of primary teeth in the upper jaw

1) I II III IV V

2) I II IV III V

3) I II IV V III

The order of eruption of primary teeth on the lower jaw

1) I II III IV V

2) I II IV III V

3) I II IV V III

Sequence of eruption of permanent teeth in the upper jaw

Sequence of eruption of permanent teeth in the lower jaw

Occlusion is the relationship in central occlusion

jaws

teeth or dentition

alveolar processes of the jaws

26. An abnormal bite, in which the teeth of the upper jaw in relation to the teeth of the lower jaw are located in a more anterior position compared to the orthognathic bite, is called

cross

prognathic

deep

progenic

The prognathic relationship of the dentition may be due to

lengthening the dental arch of the lower jaw

lengthening the dental arch of the upper jaw

shortening of the dental arch of the upper jaw

28. Progenic occlusion may be a consequence

early loss of teeth in the upper jaw

early loss of teeth in the lower jaw

lower jaw injuries

The reason contributing to the occurrence of true progenic bite may be

pituitary hyperfunction

hyperthyroidism

hyperfunction of the adrenal cortex

hyperfunction of the parathyroid glands

The causes of macrognathia of the lower jaw can be

improperly organized artificial feeding

bad habits

short frenulum of the tongue

Bite pathologies- this is a fairly common phenomenon. They can be either pronounced or minimally manifested. But even a small defect can lead to serious problems during eating. Expressed in the incorrect position of the teeth in relation to each other.

This kind of malocclusion can appear at any time, in children during the eruption of baby or permanent teeth, or in adults, due to injury or loss of teeth from the dentition.

The severity of the pathology is determined depending on the deviation from the norm. Divided into I, II and III degrees. It is worth considering what features each has.

Pathology I degree

The first degree is the norm. It is considered the most physiological for the dentition. With this arrangement of teeth, there is a displacement of 3 to 5 mm.

This is a kind of standard that specialists adhere to in the process of dentition correction. Accordingly, pathology of the 1st degree is not considered a violation, it is a pattern of teeth arrangement.

Pathology II degree

This pathology is characterized by a displacement of the dentition by a distance of 5 to 9 mm. In this case, there is a violation of the chewing function, which causes slight discomfort when eating. Pathology of the 2nd degree requires correction. A number of modern technologies are used for these purposes, but surgery can be done without surgery.

Pathology III degree

The discrepancy between the dentition is more than 9 mm. This phenomenon creates significant inconvenience when chewing. The process is carried out inefficiently, which causes problems with the gastrointestinal tract.

Also, the presence of a defect manifests itself visually, which leads to problems of a psycho-emotional nature. Eliminated through surgery.

Important! If the bite is formed incorrectly in a child or changes in an adult, you need to consult a specialist in time. Pathologies of degrees 2 and 3 can lead to the development of concomitant diseases, as well as tooth decay and gum injury.

There is a classification of bite pathologies by type of deviation. It needs to be considered in more detail.

It can occur in both children and adults. It is a horizontal intersection of the dentition or jaws.

It is strongly expressed visually, which brings moral discomfort. Occurs when there is a discrepancy in the development of the lateral parts of the jaws. There are both one-sided and two-sided.

Transversal malocclusions (crossover) are divided into lingual, palatal and buccal.

1. Lingual bite is characterized by a displacement of the jaw towards the tongue.
2. Palatinal - the jaw is shifted towards the palate.
3. Buccal - displacement is observed towards the cheek.

This anomaly occurs for a number of reasons. Among the main ones it is worth noting: traumatic factors, lack of teeth in the dentition, pathologies of the temporomandibular joint, disruption of the teething process.

The most common complaints with crossbite include:

• aesthetic defect;
• problems with chewing food;
• slurred speech;
• frequent gum injury.

Sagittal malocclusions are often combined with transverse ones. They are characterized by displacement of the jaws in relation to each other. This may be an overdeveloped lower jaw and an underdeveloped upper jaw and vice versa. Such pathologies are divided into mesial and prognathic.

In the first case, a noticeable protrusion of the upper jaw can be observed. The lower one is noticeably underdeveloped, which causes significant deformation of the face in the form of a sloping chin.

In the second case, the lower jaw is noticeably protruded, which causes a significant disproportion.

Such anomalies arise due to a different number of teeth in the jaws, pathology of the development of the alveolar processes, or pathologies of another similar type.

With such defects, the patient experiences difficulty in eating and there is blurred speech. Due to the incorrect position of the jaws, a constantly tense facial expression occurs.

The defect is eliminated in childhood (up to 11 years) with the help of modern technologies, in adults, especially in advanced cases - through surgical intervention.

According to statistics, approximately 70% of children have malocclusions. Most of them require treatment using complex techniques. Specialists experience significant difficulties when working with children. This is due to the attitude of young patients towards the event. They do not always follow doctors' recommendations, which is why treatment is ineffective.

About a third of children do not receive the necessary therapy, which subsequently causes a relapse of the disease. Bite pathologies in school-age children are in most cases accompanied by numerous carious lesions of the teeth, as well as various concomitant diseases, such as periodontal disease. Therefore, treatment must be carried out on time.

Important! Orthodontic diseases in children require long-term treatment. On average, it lasts from 10 months to one and a half years. During this period, you must carefully follow the doctor’s recommendations and come for scheduled examinations on time. They are necessary to evaluate treatment results and correct methods.

Malocclusions in children are classified into 5 types:

1. cross;
2. deep;
3. open;
4. mesial;
5. distal.

Cross occurs due to unilateral or bilateral underdevelopment of the jaws. As a result, the dentition overlaps.

A deep bite appears due to underdevelopment of the lower jaw. As a result, the upper row of teeth significantly overlaps the lower one.

An open bite is characterized by non-occlusion of the dentition over a significant segment. This pathology can appear both in the front and side of the jaw.

Mesial occlusion is characterized by an overly protruded lower jaw, which causes significant overlap of the upper dentition.

With a distal bite, the upper jaw is pushed forward, which causes the effect of a slanted chin.

All these types of malocclusions in preschoolers have certain causes. The main factors influencing the development of the jaws and the formation of the dentition are:

• Genetic factor.
• The presence of chronic diseases accompanied by difficulty in nasal breathing.
• Habit of thumb sucking and lip or tongue biting.
• Late weaning from the pacifier.
• Lack of calcium in the body.
• Injuries and damage to teeth and jaws.
• Numerous carious lesions.
• Extracting baby teeth too early or too late.

Important! Bite pathologies in children should be treated as early as possible. An advanced disease can lead to significant complications, as well as problems with chewing and speech.

Tests to determine malocclusion

When diagnosing bite pathologies, specialists use various research methods. There are already developed tables with which you can identify even minimal deviations and prevent its development at an early stage.

Tests for malocclusion are performed both by direct examination and by dental impressions. In the process, measurements are taken in various planes, and attention is paid not only to the dentition as a whole, but to the presence and location of each tooth, as well as their general condition.

Important! Even if there is no visually noticeable bite pathology, it is imperative to visit a specialist and undergo testing. It will help identify the development of anomalies at the initial stage, when deviations are minimal.

To prevent the development of anomalies, you need to follow a number of simple rules:

1. During pregnancy, you need to carefully monitor your health and eat foods rich in calcium.
2. After the birth of a child, do not transfer him to artificial feeding unless necessary. Bottle feeding affects the formation of the bite.
3. After teething, monitor their condition and visit the dentist on time.
4. Do therapeutic exercises that provide the necessary load on the facial muscles.

Prevention of malocclusion is necessary for both children and adults. Pathology can manifest at any age if appropriate factors are present. Therefore, regular examinations are necessary. If a specialist identifies a predisposition to the development of a certain disorder, he will recommend appropriate means of preventing malocclusion.

To prevent the disease, more complex measures may be needed than therapeutic exercises and compliance with a number of the rules described above. In some cases, you will need a set of devices for the prevention of malocclusions, which the doctor will select depending on the situation.

You cannot use devices to prevent malocclusions on your own, only on the recommendation of a specialist. Their unsystematic use can significantly worsen the current condition and provoke the development of pathology.

Malocclusions- these are deviations from the normal relationship of the dentition of the upper and lower jaws. These deviations can be considered in three directions:

Sagittal

Prognathia(distal bite) - characterized by a discrepancy in the relationship of the dentition due to the protrusion of the upper teeth or the distal displacement of the lower jaw. The distal bite can be partial or general; jaw, skeletal or dental; with or without displacement of the lower jaw.

Etiology: congenital structural feature of the facial skeleton, childhood diseases affecting the development of the skeletal system, inflammatory processes in the nasopharynx, etc.

Treatment for the presence of primary teeth consists not only of therapeutic, but also of preventive measures. During the period of permanent dentition, removable and non-removable orthodontic appliances and devices are used.

Progenia(mesial bite) - characterized by inconsistency of the dentition due to protrusion of the lower teeth or mesial displacement of the lower jaw. It may be partial or complete; jaw, skeletal or dental; with or without displacement of the lower jaw.

Etiology: congenital structural feature of the bones of the facial skeleton, incorrect method of artificial feeding, early loss of primary molars, etc.

Treatment consists of correcting the oral inclination of the upper incisors and should be completed before the eruption of permanent canines, i.e. before 11 years of age.

Vertical

Deep bite- a closure of the dentition in which the frontal teeth are largely overlapped by antagonists. Depending on the vestibular or oral inclination, two types of deep bite are distinguished - vertical and horizontal.

Etiology: congenital structural feature of the facial skeleton, childhood diseases affecting the growth and development of bones, early loss of primary molars...

The main objectives of treatment are the separation of the bite, the expansion of the narrowed dentition on the jaw that is lagging behind in development and, if necessary, the movement of the lower jaw.

Open bite- characterized by the presence of a gap between the teeth of central occlusion. This gap occurs more often in the area of ​​the frontal teeth. There are two forms of open bite - vertical and horizontal.

Etiology: rickets, difficulty in nasal breathing, early loss of frontal teeth, wide diastema.

Treatment before the replacement of baby teeth with permanent teeth consists of eliminating etiological factors. For permanent occlusion, orthodontic devices and intermaxillary rubber traction are used, for fixation of which Angle arches or removable mouth guards are used.

Crossbite- characterized by the reverse closure of the teeth of the right or left half of the bite.

Etiology: delay in the replacement of milk teeth by permanent ones, incorrect position of the tooth buds and subsequent incorrect eruption of these teeth, uneven development of the jaws and dental arches.

Treatment during the periods of primary and mixed dentition consists primarily of eliminating etiological factors. In the final period of teeth change and with a permanent dentition, orthodontic devices are used, as well as Katz guide crowns and Angle arches.