RU2250752C2 - Differential diagnosis method for determining pathological dental abrasion or bruxism - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves composing and studying family genealogic tree for at least three generations. Hereditary nature of the disease being discovered according to autosomal dominance sign, bruxism is diagnosed. No hereditary nature of the disease being discovered, pathological dental abrasion is diagnosed.

EFFECT: high accuracy of diagnosis.

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Description

The present invention relates to medicine, namely to dentistry.

Pathological abrasion of the teeth is a fast-moving process, accompanied by changes in the dental and peridental tissues, impaired function of the masticatory muscles and temporomandibular joint. It is not always possible to draw a clear line between the true pathological abrasion of teeth and bruxism, the complication of which is pathological abrasion. Complaints of a patient with pathological abrasion and bruxism, mainly from the dentition: aesthetic defect (violation of the anatomical shape of the tooth), increased sensitivity of enamel and dentin when taking cold, hot, sour, sweet and salty foods, shortening of the lower face, the severity of nasolabial and chin folds, pain in the temporomandibular joint, crunching, clicking, fatigue of the masticatory muscles. Despite the fact that the clinical picture of pathological abrasion of teeth and bruxism is similar, the etiology of these diseases is different, as well as their treatment.

Pathological abrasion is diagnosed according to clinical (complaints, examination, collection of anamnesis of life and disease) and paraclinical examination (determination of pulmonary excitability, radiography of teeth, jaws and temporomandibular joint, electromyography, study of the function of masticatory muscles (see Kalamkarov Kh.A. , Petrosov Yu.A. Clinic and principles of treatment of diseases of the temporomandibular joint. // Dentistry. - 1982 - No. 2 - p. 66-71).

The diagnosis of bruxism is carried out according to clinical and paraclinical examination: signs of pathological abrasion, the presence of dysfunction of the temporomandibular joint, periodontitis, electromyography data, the presence of "night gnashing" (see Zhulev E.N. Etiology, clinic and treatment of bruxism. // Dentistry. - 1976. - No. 4 - p. 95-98).

The technical result of the proposed method is to increase the accuracy of the differential diagnosis of pathological abrasion of teeth and bruxism.

What is new in achieving the set technical result is that at least three generations compose and analyze the family genealogy.

Also new is the fact that in the presence of the hereditary nature of the disease, bruxism is diagnosed on an autosomal dominant basis, and in the absence of the hereditary nature of the disease, pathological tooth morbidity is diagnosed.

Compilation and analysis of a family genealogy of at least three generations (carrying out a genetic examination) allows you to determine the hereditary or non-hereditary nature of the disease, the pathological gene and the frequency of this gene in the population. Based on the studies, the author made the following conclusions:

- the disease (bruxism) has an autosomal dominant type of inheritance;

- the disease occurs in every generation, i.e. transmitted vertically;

- the ratio of sick boys and girls 3: 1;

- sick men transmit the disease in 100% of cases to boys, and girls - if they look like a father, sick women transmit the disease only to boys.

With pathological tooth abrasion, this inheritance of the disease is not observed.

A sample size of at least three generations is necessary for accurate diagnosis of the disease, as well as diagnosis in the preclinical phase of the disease, with erased forms of the disease.

Comparative analysis with the prototype shows that the claimed method is different in that they compose and analyze a family genealogy of at least three generations and, in the presence of a hereditary nature of the disease, diagnose bruxism by an autosomal dominant feature, and in the absence of a hereditary nature of the disease, pathological abrasion is diagnosed, which meets the criterion inventions “novelty”.

The new set of features provides increased accuracy in the differential diagnosis of pathological tooth abrasion and bruxism, allows you to correctly and timely determine the amount of adequate (pathogenetic) treatment, conduct early diagnosis of bruxism in order to prevent consequences from the dentition. The patient has a history of life and disease, identifies complaints and the nature of signs of abnormal tooth abrasion, an X-ray and electromyographic study is performed. If the diagnosis is difficult, a genetic examination is carried out, a family genealogy is compiled and analyzed. When compiling a pedigree, standard methods and notation are used. The person who seeks treatment is called a proband, his brothers and sisters (siblings, cousins, second cousins) - siblings. A square denotes a man, a circle of a woman. The Roman numeral denotes the generation number, the Arabic numeral denotes the number of the individual when numbering members of one generation sequentially from left to right. The collection begins with general questions: surname, name, patronymic, age, nationality of the proband and his parents, the presence of kinship, the identification of patients with the same pathological signs, both dental and somatic. A schematic depiction of a pedigree begins with a proband marked with an arrow. The genealogy covers at least three generations. If there are relatives in 3-4 generations who suffer from dysfunction of the temporomandibular apparatus, night gnashing, abnormal tooth erasure, and the same somatic diseases, they are diagnosed with Bruxism. In the absence of relatives suffering from pathological abrasion of the teeth, pain in the temporomandibular joint, the diagnosis of pathological abrasion of the teeth.

The proposed method is illustrated by the following clinical examples.

Example 1. Patient D., 38 years old, complained of increased tooth sensitivity when taking cold and sweet foods, pain, crunching and clicking in the temporomandibular joint on the right, dizziness, feeling of stuffiness in the ear. The pains are dull, aggravated by chewing solid food. These phenomena appeared about 1.5 years ago, periodically may intensify. From the anamnesis it was found out that there were no diseases of internal organs; in childhood I had measles. For the past 7 years he has been working as a crane operator in a river port.

На окклюзионной поверхности видны площадки патологической стираемости. Справа высота коронковой части жевательных зубов стерта до контактных поверхностей, слева - стерты жевательные бугры. Слизистая оболочка десны без патологических изменений, на слизистой оболочке щек видны кровоизлияния как результат прикусывания слизистой оболочки щек острыми краями эмали. На боковой поверхности языка видны отпечатки зубов (при снижении межальвеолярной высоты, уменьшается объем собственно полости рта и появляется дефицит пространства для языка). На R-снимке височно-нижнечелюстного сустава отмечается изменение топографических взаимоотношений элементов сустава, а именно вследствие снижения межальвеолярной высоты суставная головка нижней челюсти смещается кзади и вниз, особенно справа. При электромиографическом исследовании установлено нарушение функции жевательных мышц, которое выражается в спонтанной активности в состоянии покоя.Objectively: the asymmetry of the face, the chin is shifted to the right, the lower third of the face is reduced by 2 mm, the height of the lower part of the face in the position of relative physiological rest is 7.2 cm, and in the position of central occlusion 6.7 cm. The mouth opens in full 4.5 see, at the time of opening there is a click in the temporomandibular joint on the right and at the end of the closure. The dentition of the lower jaw at the moment of closure with the teeth-antagonists is shifted to the usual occlusion. Dental formula

On the occlusal surface are visible areas of pathological abrasion. On the right, the height of the crown of the chewing teeth has been erased to the contact surfaces, on the left, the chewing tubercles have been erased. Gingival mucosa without pathological changes, hemorrhages are visible on the mucous membrane of the cheeks as a result of biting the mucous membrane of the cheeks with sharp enamel edges. Imprints of teeth are visible on the lateral surface of the tongue (with a decrease in the interalveolar height, the volume of the oral cavity proper decreases and there is a shortage of space for the tongue). In the R-image of the temporomandibular joint, a change in the topographic relationship of the elements of the joint is noted, namely, due to a decrease in the interalveolar height, the articular head of the lower jaw moves posteriorly and downward, especially to the right. An electromyographic study found a malfunction of the masticatory muscles, which is expressed in spontaneous activity at rest.

To clarify the diagnosis, the patient is a family genealogy in three generations. When studying the genealogy of relatives in three generations, there are no such signs of the disease.

Diagnosis: Pathological abrasion of 2 degrees, generalized, horizontal, complicated by malocclusion, distal shift of the lower jaw and dysfunction of the temporomandibular joint. Orthopedic treatment was prescribed in combination with physiotherapeutic treatment (laser therapy No. 5 at trigger points and myogymnastics for 10 minutes 4 times a day for 2 months).

Example 2. Patient M., 48 years old. He complained of clicks in the temporomandibular joint, pain in the chewing muscles, and increased tooth sensitivity when taking cold, hot, sweet, and acidic foods. From the anamnesis: symptoms appeared 2 years ago. For many years working as a crane operator in the construction of residential buildings. Objectively: the lower third of the face is reduced by 2 mm. The height of the lower part of the face in the position of central occlusion is 6.4 cm, in the position of relative physiological rest 6.2 cm. The mouth opens by 4.5 cm, zigzag. On the mucous membrane of the cheeks there are imprints of the line of closure of the teeth, as well as on the lateral surface of the tongue, the mucous membrane of the gingival margin is pale pink. Dental formula

On the occlusal surface of the chewing teeth and the cutting edges of the incisors there are pathological abrasion areas within the chewing tubercles, the ratio of the dentition is orthognathic. Palpation of the masticatory muscles is painless. X-ray examination revealed a slight displacement of the head of the lower jaw posteriorly. An electromyographic study also revealed impaired coordination of the masticatory muscles and spontaneous activity at rest. To clarify the diagnosis, the patient is examined in a family genealogy in 4 generations. The results of the genetic examination are shown in the diagram (see drawing), where the square indicates the man, the circle - the woman. The Roman numeral denotes the generation number, the Arabic numeral denotes the number of the individual when numbering members of one generation sequentially from right to left, crossed out circles and squares - patients with bruxism, proband is marked with an arrow. After analyzing the family genealogy, the author found out that the disease has a genetic nature (hereditary), is transmitted vertically according to an autosomal dominant trait. The examined patient has a grandmother, father, all brothers and sisters have significant tooth abrasion, signs of bruxism. His wife is healthy, there are two children - a son and a daughter. The son is 14 years old, he grinds his teeth during sleep, talks, sleeps restlessly. Sleep late, wake up with difficulty and late. Suffers from a decreased concentration of attention, irritable, impulsive, there are headaches of the neuromuscular type. These same symptoms are characteristic of both the subject and all family members suffering from bruxism. The son of proband found pathological abrasion of teeth of mild severity, localized in the region of _543 teeth of the lower row, tooth prints on the lateral surface of the tongue and mucous membrane of the cheeks, pain in the area of the temporomandibular joint. Based on the analysis of the family pedigree, the diagnosis was made: Bruxism.

Claims (1)

A method for differential diagnosis of pathological abrasion of teeth and bruxism by clinical and paraclinical examination, characterized in that they compile and analyze a family genealogy of at least three generations and, in the presence of a hereditary nature of the disease, diagnose bruxism in an autosomal dominant way, and in the absence of a hereditary nature of the disease, diagnose pathological abrasion teeth.