RU2624360C1 - Method for assessment of chewing muscles parafunction treatment results - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: chewing muscles tone and synchronism are determined, the amplitude of mouth opening is measured and the subjective assessment of patient's symptoms is taken into account. The functional state in the chewing muscles is scored. Both at the stage of diagnosis, and after the performed dental treatment, the percentage of decrease in the disease symptoms is calculated by the mathematical formula. Depending on the value obtained, a complete cure, an excellent result, a good result, a satisfactory result, a minor result or no result are determined.

EFFECT: method allows to evaluate the effectiveness of chewing muscles parafunction treatment by determining the functional state of the chewing muscles and subjective evaluation of the disease symptoms.

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Description

The invention relates to medicine, namely to dentistry, and can be used to evaluate the dental treatment of masticatory muscle parafunction.

Parafunction is called increased inappropriate muscle activity that is not associated with physiological acts of swallowing, chewing and speech formation.

In the pathogenesis of parafunctions, a weakening, and sometimes a violation of the central nervous system control of muscle contractions and efforts, which develop masticatory or facial muscles, as well as muscles of the tongue, plays a role. Chewing muscle parafunctions are more common in people whose professional activity takes place in extreme conditions requiring excessive psychoemotional and physical stress.

Currently, several classifications of masticatory parafunction are used.

E.I. Gavrilov and V.D. Panteleev (see Gavrilov A.I., Panteleev V.D. Clinical forms of masticatory muscle parafunction // Dentistry. 1987. - T. 66, No. 4. - P. 40-43) identified the following clinical forms of masticatory muscle parafunctions:

1. Compression of teeth, characterized by a violation of the state of relative rest of the lower jaw due to the tonic contraction of the muscles that lift it. Unconscious compression of the teeth occurs when they close in the central occlusion or alternately - right or left on the lateral teeth. The compression force of the teeth depends on the size of the mental load or stressful situation and other external stimuli. Often, the contraction of the chewing muscles proper is accompanied by the formation of seals (“nodules”) in them, which patients can discover when watching TV shows, shaving their faces, during meetings, etc.

2. Chewing without chewing is characterized by grinding lateral movements of the lower jaw with a very small amplitude. The teeth in this case, as a rule, are closed. Usually this habit is characteristic of elderly people and may be associated with poor fixation of removable dentures. By compressing the dentition, they try to fix the removable prosthesis to the tissues of the prosthetic bed. At first, chewing without food is detected only in the evenings during rest, and then the bad habit progresses and is observed in the daytime.

3. Teeth grinding is characterized by lateral movements of the lower jaw with compressed dentition, which is accompanied by a typical sound. More often, gnashing of teeth occurs at night, so they usually learn about this bad habit from others, but sometimes they notice it themselves, suddenly waking up.

N.Yu. Seferyan (see N.Yu. Clinic and complex treatment of parafunctions of the masticatory, facial muscles and muscles of the tongue: abstract of dissertation of the candidate of medical sciences: 14.00.21 / N.Yu. Seferyan; Tver state medical academy. Tver , 1998. - 19 pp.) An expanded clinical classification of diseases in violation of the neuromuscular complex of the dentofacial region was developed and proposed.

In the working classification proposed by this author, parafunctions are divided into six groups:

1) Parafunction of the masticatory muscles that raise the lower jaw (i.e. masseter, i.e. temporalis, i.e. pterygoideus medialis):

- Bruxism (night, day, combined).

- Hypertrophy of the muscles (unilateral, bilateral).

- Hypertonicity of the lateral pterygoid muscle (unilateral, bilateral).

- muscle fatigue.

2) Parafunction of the masticatory muscles lowering the lower jaw (i.e. digastricus, i.e. geniohyoideus, mylohyoideus):

- Hyperkinesis of these muscles.

- Atony of these muscles.

3) Parafunction of the masticatory muscles in combination with a dysfunctional state of the temporomandibular joints.

- Parafunction of the masticatory muscles in combination with neuromuscular dysfunctional TMJ syndrome.

- Parafunction of the masticatory muscles in combination with the usual dislocations and subluxations of the lower jaw.

- Parafunction of the masticatory muscles in combination with dislocations of the intraarticular meniscus of the TMJ.

4) Parafunction of facial muscles:

- Random chaotic movements of the lips and cheeks.

- Imaginary chewing.

- A sharp periodic compression of the lips and cheeks.

5) Parafunction of the muscles of the tongue:

- Erratic language movements.

- Periodic emphasis with the tip of the tongue on the cheek.

- Sucking the tongue.

6) The combination of parafunctions of the masticatory, facial and tongue muscles.

Abroad use the following classification of parafunctions:

1) Parafunctions associated with the action of chewing muscles.

2) Parafunctions caused by the action of lips, tongue, cheeks.

3) Hypofunctional parafunctions.

The above classifications of masticatory parafunctions are based on either the etiology of the disease or the name of the muscles in which parafunction is observed. However, at present, there is no classification of masticatory parafunction by the severity of the disease.

There is a method of evaluating the aesthetic results of dental treatment (see RU No. 2463955, A61B 5/107, A61B 10/00, 10/20/2012) where significant aesthetic characteristics of the face are evaluated before and after treatment: symmetry of the features (C), the condition of the teeth is aesthetically significant zone (SZ), the naturalness of facial expressions (M) and a smile (U) according to the formula: IE = (C + C3 + M + U): 4, where IE is the index of the overall aesthetic result of dental treatment. The treatment results are divided into 3 groups: they set the highest score of 100 points, while one point corresponds to one percent, and the overall aesthetic result is rated as good with IE, equal to 95-100 points, as satisfactory - from 90 to 94 points and unsatisfactory when IE less than 90 points

The disadvantages of this method are: 1) dividing the treatment results into only 3 groups, which reduces the accuracy of the assessment; 2) the inability to assess the results of treatment of masticatory muscle parafunction disease.

Closest to the proposed is a method for assessing the quality of the results of endodontic treatment of complicated forms of dental caries (see patent RU No. 2557712, A61B 5/00, 07/27/2015) - a prototype that includes an assessment of clinical and medical history of teeth, taking into account the anamnesis and the presence of symptoms characteristic for various forms of chronic periodontitis, as well as the radiological characteristics of the state of the periapical tissues of the teeth, including the assessment of changes in the periodontal gap, cortical plate, bone marrow spaces, the presence of foci of ineralizatsii cancellous bone, bone trabeculae state pattern and extent of formation of root apex depending on the nature of periapical lesions, followed by calculation of the mathematical value of the complex index. The results are divided into 3 groups: full tightness of the root filling; poor tightness of the root filling, where the risk of developing periapical complications is minimized, and poor tightness of the root filling with a high probability of post-endodontic complications.

The disadvantages of this method are: 1) the division of the results into only 3 groups, which reduces the accuracy of the assessment; 2) the inability to assess the results of treatment of the disease of the masticatory muscle parafunction.

The objective of the invention is to assess the effectiveness of the treatment of parafunction of the masticatory muscles after dental treatment.

This object is achieved in that in the method for evaluating the results of treatment of masticatory muscle parafunction, including a score for the functional state of the patient's masticatory muscles, the tone and synchronism of the masticatory muscles are determined, the amplitude of the mouth opening is measured, and the subjective assessment of the patient’s disease symptoms is taken into account; chewing muscles from 1 to 9 points, where 1 point corresponds to the absence of anxiety, and 9 points - extremely worries according to Table 1, indicated d herein, both at the stage of diagnosis, and after the spent dental treatment, and percentage reduction calculated by the formula of symptoms

,

,

where y ₁ is the number of points before treatment;

₂ - the number of points at which there are no symptoms of the disease is always 11;

₃ - the number of points after treatment;

X is the percentage of treatment results;

Δ is the difference in points,

and with an X value of 100%, a complete cure is determined; from 75 to 99% are defined as excellent results; from 50 to 74% as a good result; from 25 to 49% as a satisfactory result; from 1 to 24% as an insignificant result, and at 0% determine the absence of a result.

The patient, both at the diagnostic stage and after the dental treatment, scores the functional state of the masticatory muscles, determines the tone and synchronism of the masticatory muscles, and measures the amplitude of the mouth opening. The results of the doctor’s diagnosis and subjective assessment of the patient’s disease symptoms are entered into the table (see Table 1) and a functional state of the masticatory muscles is scored, and the severity of the disease symptoms is scored from 1 to 9, then the scores are summarized and depending on the number of scores the severity of parafunction of the masticatory muscles is determined:

11 points - there are no symptoms of masticatory parafunction;

12-40 points - mild severity of masticatory muscle parafunction;

41-70 points - moderate severity of masticatory muscle parafunction;

71-99 points - a severe severity of parafunction of the masticatory muscles.

The first part of the scoring of the functional state of the masticatory muscles is filled by the patient. He is asked to assess the severity of the sensations of the disease, using concepts such as “extremely”, “strongly”, “moderately”, “weakly”, “do not bother”, each of which has a mark. The patient marks the result of such self-assessment with a “cross” or “checkmark” in the corresponding column of the table (see table. 1). If it is difficult for the patient to give an unambiguous assessment of the severity of individual symptoms or manifestations of the disease, he can indicate an intermediate assessment - put a “cross” in the interval between the above concepts: extremely, strongly, moderately, weakly, does not bother. There are questions in which it is necessary to note the area that bothers the patient. For example, pain in the masticatory muscles (indicate area); increased tone of the masticatory muscles (indicate area); Chewing muscle fatigue (indicate area). To do this, at the end of the question, a drawing of the human head is depicted, where the patient shades those areas on the head that bother him. The patient estimates the degree of strength of pain in the masticatory muscles in scores from 1 to 9. The patient evaluates questions about the difficulty of eating and anxiety about the outcome of the disease using the concepts of “extremely”, “strong”, “moderate”, “weak”, “do not disturb ". The second part of the scoring of the functional state of the masticatory muscles is filled by the dentist. The doctor palpation determines the tone of the masticatory muscles and evaluates their synchronism of work. To determine the amplitude of the opening of the mouth, the doctor uses a measuring ruler. The results are tabulated. Then the points are summarized. Depending on the number of points, the severity of the chewing muscle parafunction is determined. The expression in integers of the main and intermediate estimates greatly facilitates the mathematical processing of the research results.

A method for evaluating the results of treatment of masticatory muscle parafunction is to analyze the results of a scoring of the functional state of the patient's masticatory muscles both at the diagnostic stage and after the dental treatment. To assess the result of treatment of a disease of the masticatory muscle parafunction, it is necessary to calculate the percentage reduction in the symptoms of the disease, which is calculated by the formula

where y ₁ is the number of points before treatment;

₂ - the number of points at which there are no symptoms of the disease is always 11;

y ₃ is the number of points after treatment;

X is the percentage of treatment results;

Δ is the difference in points,

then the result obtained is determined in one of 6 groups — excellent result, good result, satisfactory result, insignificant result, lack of result (or it got worse).

1. A complete cure - if the patient has no complaints and symptoms of the disease at the time of treatment, a 100% reduction in the symptoms of the disease.

2. An excellent result - if the patient's symptoms of the disease decreased from 75 to 99% at the end of treatment.

3. A good result is if the patient's symptoms of the disease have decreased from 50 to 74% at the time of treatment.

4. A satisfactory result - if the patient has decreased from 25 to 49% at the time of treatment completion.

5. An insignificant result - if the patient's symptoms of the disease decreased from 1 to 24% at the end of treatment.

6. Lack of result (or got worse) - if the patient had all the symptoms of the disease at the time of treatment completion or the patient got worse than 0%.

Thus, the proposed method for evaluating the results of treatment of masticatory muscle parafunction allows, based on a comparison of the severity of symptoms before and after treatment, to evaluate its effectiveness.

Clinical example

Patient M., 47 years old, came to the clinic with complaints of fatigue of the masticatory muscles, which manifests itself most often in the morning. About 7 years ago, the patient began to pay attention to what strongly compresses the teeth and grinds them. After filling out a patient's scoring of the functional state of the masticatory muscles, it was found out: the patient complains of pain in the masticatory muscles in two areas, assessing their pain by 5 points. The patient notes an increased tone of the masticatory muscles of the same areas for 4 hours daily, and in the morning complains of their fatigue. The patient assesses her difficulty in eating and anxiety for the outcome of the disease by 4 points, marking with a cross the intermediate result between the concepts is moderate and weak. After examining the dentist’s doctor and filling out a scoring of the functional state of the masticatory muscles, they found that patient M. has an increased tone m. Masseter on both sides and decreased tone m. temporalis sinistra. Marked asynchronous operation m. temporalis. The amplitude of the opening of the mouth after measurement was 34 mm. After processing the results of a scoring of the functional state of the masticatory muscles of patient M., the number of points scored was 48, which indicates the moderate severity of masticatory muscle parafunction. Patient M. was treated for masticatory parafunction disease. After the dental treatment, the patient notes that the pain in the masticatory muscles, the feeling of increased tone and fatigue of the masticatory muscles have completely passed. Patient M. stopped complaining about the difficulty of eating and there is no longer anxiety about the outcome of the disease. After examination by a dentist, it was found out that patient M. remained in low tone m. temporalis sinistra. The amplitude of the opening of the mouth increased from 34 mm to 38 mm. After re-scoring the functional state of the patient's masticatory muscles after dental treatment, the number of points on the questionnaire was 15, which indicates a mild severity of masticatory muscle parafunction.

Using the equations to evaluate the treatment, we obtain:

1. The difference in scores at which patient M. at the time of treatment could have completely cured the disease 100%, the decrease in the symptoms of the disease (Δ ₁ ) is 48-11 = 37.

2. The difference in scores before and after the treatment (Δ ₂ ) is 48-15 = 33.

3. y ₁ = 48 (number of points before treatment).

4. ₂ = 11 (the number of points at which there are no symptoms of the disease is always 11 (see table. 1)).

5. ₃ = 15 (the number of points after treatment).

To determine the percentage reduction in complaints and symptoms of the disease of patient M., we use the equation

X = 89.2%. This means that in patient M., at the end of treatment, the symptoms of the disease decreased by 89.2%, which indicates an excellent result in the treatment of masticatory parafunction of patient M.

The proposed method allows to evaluate the effectiveness of the treatment of parafunction of the masticatory muscles.

Claims (8)

A method for evaluating the results of treatment of masticatory muscle parafunction, including a scoring of the functional state of the masticatory muscles of the patient, characterized in that the tonus and synchronism of the masticatory muscles are determined, the amplitude of the opening of the mouth is measured, and a subjective assessment of the patient’s disease symptoms is taken into account; 1 to 9 points, where 1 point corresponds to the absence of anxiety, and 9 points is extremely disturbing according to Table 1 indicated in the description, and in step to diagnosis and conducted after dental treatment, and calculating the percentage decrease of disease symptoms formula:

, where y ₁ is the number of points before treatment; ₂ - the number of points at which there are no symptoms of the disease is always 11; ₃ - the number of points after treatment; X is the percentage of treatment results; Δ is the difference in points, and with an X value of 100%, a complete cure is determined; from 75 to 99% are defined as excellent results; from 50 to 74% - as a good result; from 25 to 49% - as a satisfactory result; from 1 to 24% - as an insignificant result, and at 0% determine the absence of a result.