Occlusion

Occlusion

Occlusion is the area of dentistry that treats problems related to the mandibular temperate joint (TMJ), masticatory muscles and craniomandibular disorders.

As patologias associadas a estas disfunções podem provocar dor orofacial. A dor orofacial é “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage mediated by specific nerve fibers in relation to the brain, where its conscious perception can be modified by several factors” International Association for the Study of Pain – IASP
About 10 – 15% of patients with TMJ pain cannot be treated and live with chronic pain.
Pain can have several origins, namely: Dental, joint, muscular and psychological. Having the dentist as the goal to reduce or eliminate pain and rehabilitate.
The diagnosis must be well defined and a good clinical history (identifying the etiological factors), clinical examination, candilar and muscular palpation, imaging examinations and study of the articulator models must be performed.
Pathologies associated with occlusion problems:

Bruxism and Stress:
Bruxism consists of squeezing or grinding the teeth with a force ranging from 330 to 750 pounds of intensity; consciously or unconsciously, day or night. It is a neurophysiological disorder that exerts mandibular movements, progressive, that destroy the dental tissues (enamel and dentin).
Its etiology is related to triggering factors (eg occlusal interference) and psychic factors (stress or anxiety).
Bruxism can be further divided into centric or eccentric.
Centric bruxism: teeth exert vertical wear, it is more associated with daytime bruxism and teeth tend to over tighten. There is less wear, however there is greater muscle impairment, since the same muscle groups are always contracted (muscle pain).
Eccentric bruxism: teeth undergo horizontal wear, and associated with nocturnal bruxism, there is a grinding of the teeth. However, there is more wear on the teeth, but less muscle involvement. Teeth have a smoother, shinier surface.
80-90% of the child population also show signs and symptoms of bruxism.
Therapeutic approach: the pharmacology of anxiolytics and muscle relaxants can be used. But the dentist should advise the patient to perform an occlusal gutter, in order to relax the TMJ and not wear out the teeth.

Meniscal Dislocation:
It is a temporomandibular disorder. They may appear due to excessive force on the joint (trauma or prolonged time), which affects the condyle/meniscus/eminence relationship and causes pain/dysfunction. This retrodisc compression can lead to pain.
In pain, there is an inflammatory process that presupposes the appearance of Arthralgia.
In dysfunction, there is an alteration or modification of the position, it appears that there are bumps, difficulty in opening, because the disc may be in another position and the condyle cannot recapture the disc.
Dislocation can be complete or partial and with reduction or without reduction (position of the disc in relation to the condyle of the mandible).
Signs of reduced dislocation can be: clicks during opening and closing, images with bone changes and pain in movement. Your treatment will be to perform a relaxation drip and in case of arthralgia, prescribe painkillers.
In meniscal dislocation without reduction, clicks in the mouth opening, pain and mandibular blockage, hyperactivity of the temporal and masseter muscles can be observed. In acute phases a repositioning gutter can be performed. In the chronic phase one may have to resort to surgery.
There are several therapeutic options for occlusion pathologies and depending on the state of the lesions, one can resort to:

  • Pharmacological options: eg. anxiolytics, muscle relaxants, analgesics, anti-inflammatory drugs and corticosteroids.
  • Physical therapy: thermotherapy, cryotherapy, ultrasound, electrogalvanic excitability therapy, cold laser and acupuncture.
  • Behavioral therapy: Helps to change parafunctional habits and helps reduce stress, bad health habits, chemical dependency, emotional changes, noncompliance with therapy, among others.
  • Surgical treatment: Arthrocentesis (used more as a diagnosis); Arthroscopy; Arthrotomy (disc repositioning and stabilization) and coronoidectomy.
  • Gutter Therapy: Removable acrylic appliance that is placed on the occlusal surface of the maxillary or mandibular teeth and allows for precise occlusal contacts with the teeth of the opposite arch. Its objective is to create a more stable orthopedic position, thus producing changes in muscle and ligament contractility, promoting the deprogramming of the generated hypercontractility. Stabilizes and improves TJM function; Protects teeth and structures from abnormal forces (attrition and traumatic loads); And reorganizes neuromuscular reflex activity (reduces abnormal neuromuscular activity);

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