Treatment of distal occlusion in adults and children

Dental practice shows that distal occlusion is a common phenomenon in which the upper jaw does not close with the lower one, but protrudes noticeably above it, exceeding the established norm. This defect is also called: distal occlusion, prognathic occlusion, prognathia, posterior occlusion.

Forms

There are 4 types of prognathic bite, in which deviations are observed:

• underdeveloped lower jaw;
• too large upper jaw with very large teeth compared to the lower ones;
• both of these pathologies at the same time;
• noticeable protrusion of the anterior upper teeth above the lower ones.

The upper teeth may be twisted, fan-shaped. The central teeth of the upper row are inclined towards the palate, the side teeth are turned towards the lips.

Symptoms

In addition to the listed defects, distal occlusion is expressed by the following facial features:

• abnormal bulge of the face;
• a noticeably shortened lower part with an underdeveloped chin (bird's face syndrome);
• raised upper lip that does not cover the teeth;
• retraction of the lower lip behind the upper teeth;
• fold on the chin;
• lack of closure of teeth;
• malposition of the lips due to the tilt or misalignment of the teeth.

Causes

The following factors contribute to the development of prognathism:

• hereditary, which is quite common;
• birth injury;
• early transfer of the child to artificial nutrition, when the lower jaw has not yet had time to take the correct shape, which is achieved by jaw movements only during breastfeeding;
• long-term use of milk bottles and pacifiers, preventing the jaws from forming correctly;
• the development of rickets against the background of a lack of vitamin D, which contributes to late teething and their incorrect location in the oral cavity;
• short frenulum of the tongue;
• bad habits of sucking toys, fingers, tongue, cheeks, lips; bite nails, pens, pencils;
• malnutrition with a lack of calcium and fluoride in the body;
• inadequate intake of solid foods;
• loss of milk teeth earlier or later than normal;
• lack of timely prosthetics;
• congenital pathology of jaw development;
• violation of posture;
• trauma and disease of the jaw;
• deep caries of lateral teeth;
• chronic disease of the nasopharynx.

Problems and consequences

In the presence of a distal bite, a person experiences certain difficulties associated with:

• chewing food, as the functions of the dentition are impaired;
• rapid abrasion of teeth, leading to the development of caries and gum disease;
• pain in the jaws and temples while eating;
• the risk of dental injury;
• breathing;
• damage to the oral mucosa;
• impaired speech due to incorrect position of the tongue;
• disproportion of the face, which causes psychological problems, reducing self-esteem.

Consequences

With occlusion, various complications can occur, for example, a deep lesion of the periodontium - the periodontal tissue, as a result of which you can lose teeth.

Often there are difficulties in the process of prosthetics, pathological facial expressions, diseases of the hearing organs and the digestive system are observed.

Diagnostics

The distal occlusion is evaluated and diagnosed based on the results of laboratory tests.

Teleroentgenography

This technique is the main one in modern dental diagnostics, it reveals the presence of imbalances in bone and soft tissues, allows them to be analyzed, which facilitates the establishment of the correct diagnosis and the preparation of an effective treatment plan for the disease.

There are several types of teleroentgenogram: frontal, profile, axial (auxiliary).

Tomography 

This is a layered x-ray image used to refine the defect. A modern way to study a slice (layer) is computed tomography, which makes it possible to reduce the harmful load of X-rays on the body and, in difficult cases, to establish the diagnosis as accurately as possible.

Electromyography (EMG)

The method is used when it is necessary to evaluate the functions of the dentoalveolar system. There are three EMG methods:

• interference (general) with the application of electrodes to the skin;
• local with needle electrodes;
• stimulation to measure the speed of movement of an electrical impulse from a given point to the nerve or muscle under study.

Rheography

A method for determining the state of blood vessels, during which an alternating current of high frequency is passed through the studied tissues of the body.

Production and analysis of diagnostic models of the jaws

It is a valuable diagnostic method due to its simplicity, accessibility, high information content. Models for diagnostics are made of high-strength gypsum.

Treatment

A necessary part of the treatment is the elimination of the causes that began the development of the anomaly: diseases, bad habits, injuries, and other factors described above.

Previously, the doctor eliminates existing dental diseases, removes tartar, performs prosthetics, if necessary.

There are several methods for correcting occlusion:

• myogymnastics, designed to strengthen the circular muscles of the mouth and masticatory muscles;
• orthodontic therapy used for adults (for example, using braces - non-removable structures to correct the position of the teeth);
• hardware-surgical treatment, in which the removal of one or several teeth is necessary to align the jaws;
• combined therapy with the additional help of specialists: a periodontist, a dentist-therapist, a speech therapist, an otolaryngologist.

Myogymnastics

The greatest result can be achieved by the following exercise: move the lower jaw forward and backward at a slow pace. In this case, the maximum forward position must be fixed for 10 seconds. Such facial gymnastics is done 10 times in a row several times a day.

Bracket systems

In the treatment of occlusion, the use of non-removable braces, which are attached to the inner or outer surface of the teeth, is widespread. In this case, facial arches and facial plates (titanium and absorbable) can be additionally used.

In orthodontics, several types of braces are used, depending on the materials, location, and principle of operation:

• ceramic;
• metal;
• sapphire (invisible and therefore the most aesthetic);
• lingual (on the inside of the dentition);
• self-ligating (with a sparing effect on the movement of teeth).

Surgical intervention

This technique is chosen in difficult cases with open bites, facial asymmetry, abnormal chin shape and is performed on the jaws under general anesthesia.

Features of treatment in childhood

For children from 5 to 8 years old, removable structures are used: trainers (silicone devices for straightening teeth), dental mouth guards (transparent removable plates designed to eliminate defects in the dentition). Braces are recommended from the age of 12.

• Myogymnastics . For the normal development of the child's dentition, it is necessary to monitor the development of his lower jaw. Perform the exercise several times a day: grab the upper lip with the lower lip and hold it for 2-3 minutes.
• Kappas . If a child has a bad habit of sucking his lower lip, then metal mouth guards are used with a soldered bow, covered with a layer of plastic and spaced 2-3 mm from the teeth.
• Vestibular-lingual plate . It is installed with a distal occlusion in combination with an open one, when the upper and lower teeth cannot be connected, which is considered the most severe form of pathology. The apparatus consists of two plates (vestibular and lingual) connected by a wire.
• Plate with wire bends . The serpentine-shaped apparatus is attached to the lower jaw. The design allows the additional use of a screw for expanding the jaws and inclined plates on the side parts located opposite the problem area in order to properly form both jaws.

Taking into account the indications and contraindications, the orthodontist will choose the most appropriate technique.

• retention devices . Helps to maintain the correct position of the teeth after treatment. Structures (retainers) can be removable made of plastic and non-removable made of metal. The success of the correction of the distal occlusion largely depends on the discipline of the patient during the retention period.

Prevention

It is necessary to take mandatory measures to prevent pathology:

• breast-feeding;
• timely transfer of the child to solid food;
• the presence in the diet of foods containing calcium;
• prevention of rickets (eating foods with vitamin D);
• control over the correct posture from childhood;
• perform special exercises to maintain respiratory functions;
• weaning from bad habits: sucking a pacifier, fingers, objects; bite your nails.

When correcting distal occlusion, it should be learned that this pathology is easier and more effective to correct in childhood, following the recommendations of an orthodontist and regularly observing preventive measures.