Medicine

K. A. Semenov, Candidate of Medical Science

Food Intake Technique in the Context of Diseases of the Temporomandibular Joint

Department of Dentistry of the Faculty of Postgraduate Education, State Institution “Dnipropetrovsk Medical Academy of Health Ministry of Ukraine”.

Summary

The lower jaw bone is moved by masseter muscles, thus it may be overloaded due to the uneven distribution of a masticating pressure in the jaw bone when there is a violation of occlusive interrelations between teeth of upper and lower jaw bones. In which case a certain stereotype of chewing food and joining of teeth in the dental arch is formed. This leads to microtraumas of temporomandibular joint elements and its functional disoders.

We recommend to apply a special technique for oral food intake to decrease the pressure on temporomandibular joint elements.

Key words: the temporomandibular joint, food intake technique.

к.мед.н. Семенов К. А.

Техника приема пищи при заболеваниях височно – нижнечелюстного сустава.

Кафедра стоматологии ФПО, ГУ «Днепропетровская медицинская академия» Министерства здравоохранения Украины.

Резюме

Движением нижней челюсти управляют жевательные мышцы, которые могут быть перегружены за счет неравномерного распределения жевательного давления в челюсти при нарушении окклюзионных взаимоотношений зубов верхней и нижней челюстей. При этом будет формироваться определенный стереотип пережевывания пищи и смыкания зубов в зубном ряду, которые приведут к микротравмам элементов височно – нижнечелюстного сустава и его функциональным нарушениям.

Для снижения нагрузок на элементы височно – нижнечелюстного сустава нами рекомендована техника внесения пищи в ротовую полость.

Ключевые слова: височно – нижнечелюстной сустав, техника приема пищи.

к.мед.н. Семенов К. А

Техніка прийому їжі при захворюваннях скронево – нижньощелепного суглоба.

Кафедра стоматології ФПО, ДЗ «Дніпропетровська медична академія» Міністерства охорони здоров'я України.

Резюме

Рухом нижньої щелепи керують жувальні м'язи, які можуть бути перевантажені за рахунок нерівномірного розподілу жувального тиску в щелепі при порушенні оклюзійних взаємин зубів верхньої і нижньої щелеп. При цьому буде формуватися певний стереотип пережовування їжі і змикання зубів у зубному ряду, які призведуть до мікротравм елементів скронево – нижньощелепного суглоба та його функціональних порушень.

Для зниження навантажень на елементи скронево – нижньощелепного суглоба нами рекомендована техніка внесення їжі в ротову порожнину.

Ключові слова: скронево – нижньощелепний суглоб, техніка прийому їжі.

Recently the number of patients with diseases of the temporomandibular joint (TMJ) has grown. The interest to this pathology remains rather high, as a lot of aspects of this issue remain disputable and underinvestigated till the present moment. The most frequent pathologies of the TMJ are arthritis, arthrosis and joint and muscle disfunction [A. A. Timofeev , S. V. Maksimcha, V. P. Novinsky 2012, V. A. Margunskaya, T. B. Lyudchik 2012]. [6, 7, 8, 9].

The appearance of TMJ disorders often happens suddenly, except for an acute trauma (hit into the juxta-articular area, falling on the jaw, sudden maximum opening of the mouth). There is a particular dependency of a chronic overload of the group of muscles at the enforced one-side chewing, pathological occlusion, partial secondary edentia, long term of emergence of dentes serotini. As a result there is a myopachynsis at the working side which leads to a steady joint dysfunction. The main symptoms of this are clicking in the TMJ, locking at the movement of the lower jaw bone, muscular fatigue at chewing, impossibility to bite, disorders in the joining of teeth, and arthralgia [N. G. Abolmasov, Ye. N. Riabokon, 2006; Y. Ide, K. Nakazava, A. V. Hvatova, 2001, S. M. Shuvalov, A. V. Silin, R. A. Mirza, 2013; I. V. Miheeva 2012; Wang Y. Edwin, Fleisher A. Kenneth, 2008]. [5, 9].

Nowadays diseases of the temporomandibular joint become rather spread. Changes in the structures of the temporomandibular joint (TMJ) are most frequently connected with the individual features of the structure of dentoalveolar apparatus. In the process of swalling, when masseter muscles cotract reflexively and surfaces of teeth close, a movement pattern of the lower jaw bone depends on the position of teeth in the dental arch and their correlation with each other [1, 4].

The lower jaw bone is moved by masseter muscles which may be overloaded due to the uneven distribution of a masticating pressure in the jaw bone when there is a violation of the integrity of the dental arch. In which case a certain stereotype of chewing food and joining of teeth in the dental arch is formed. This leads to microtraumas of temporomandibular joint elements. Taking into account that the temporomandibular joint is pairing and synchronically working organ, changes in the one side of the dental arch will definitely affect the work of the emporomandibular joint elements of the other side. [1, 4, 5]

The integrity of the dental arch and the uniform distribution of masticatory pressure is the basic requirement for the smooth operation of temporomandibular joint elements.

Disorders in dentoalveolar apparatus are the starting point in the development of TMJ arthritis. The basis of the chronic arthritis is a TMJ pain-syndrome. Many authors explain the development of the pain-syndrome as follows: in cases when in the process of joining of dental arches individual teeth or their parts come into contact earlier then others, obstacles to join the entire dental arch are created, and this results in the displacement of the lower jaw bone into a forced position. This in its turn leads to a change in the position of the condyles. The function of masseter muscles changes reflexively, chewing is reformed thus resulting in microtraumas of joint elements and the violation of their physiological exchange. [1, 3, 4]

We recommend to apply a special technique for oral food intake to decrease the pressure on temporomandibular joint elements.

The technique for oral food intake in the context of diseases of the temporomandibular joint is as follows: the patient is allowed to eat usual food familiar to him, but it is necessary to put it into the mouth in small uniform pieces in order not to overload the ligamentous apparatus of the joint while opening the mouth. The obligatory condition is to put small pieces of food with a nonoperating hand. If a person is a "right-handed", the left hand is used, and if he is a"left-handed" the right hand is used. At this point a knife and a fork come to the rescue, comfortably small pieces of food are cut with a knife and put into the oral cavity with a fork according to the rules of etiquette. When the food is brought to the oral cavity by a nonoperating hand, the inborn reflex triggers and the mouth opens in parallel with the median line. Coordination of movements in the human body is carried out by the coordinated activity of the cerebral cortex of the brain, the cerebellum, and the vestibular apparatus. The leading organ of coordination is the cerebellum which regulates muscle tone. When the food is brought by a nonoperating hand, a synchronization of a muscle component of the dentoalveolar apparatus takes place, as the hand is moving towards the nose tip (the finger-to-nose test) [2]. The mouth opens in parallel with the median line and this makes the distribution of load to the muscular and ligamentous component of the temporomandibular joint more even. If the food is liquid, it is necessary to use a dessert spoon, which is poured into the oral cavity in a habitual way, but it is important to avoid opening the mouth widely. When eating the food that is put into the mouth with hands, such as bread, fruit, pieces of vegetables, seeds, nuts, it is necessary to create a comfortably small pieces and put them with a nonoperating hand trying to distribute them evenly to the left and right sides of the dentoalveolar apparatus while chewing.

Currently there is no universal method or an ideal scheme for treatment of jaw joint diseases. Complex approach to the problem of pathology of the temporomandibular joint regarding all the factors affecting disorders in the functional work of the joint allows to stabilize the development of such pathology and relieve the patient's condition in the periods of recrudescence.

Conclusions:

The proposed food intake technique in the context of diseases of the temporomandibular joint is one of the ways to reduce the load to temporo-mandibular joint elements due to a narrow opening of the mouth and even distribution of the food chewed in the oral cavity.

Opening of the mouth in parallel with the median line provides a more even distribution of load to the muscular and ligamentous components of the temporomandibular joint of the left and right sides.

Bibliography

1. Gross M. D., G. D. Matthews, Normalization of occlusion: Moscow: Medicine. – 1986. – 286 p.

2. E. I. Gusev D. C. Burd A. N. Konovalov Text-book in neurology and neurosurgery. Rostov-on-Don. Publisher Phoenix 2006. – 692 p.

3. Korzh N. A., Khvisyuk A. N., Deduh N. V. Osteoarthritis: Kharkov: Golden pages. – 2007. – 424 p.

4. M. Kliaynrok Functional disorders of the motor unit of the masticatory apparatus. – Lvov. – "Galdent". – 2015. – 256 p.

5. E. Ralf, McDonald, Davida R. Avery. Children and teenagers dentistry. – Moscow: Medical dental agency. – 2003. – 766 p.

6. Robustova T. G., Dental surgery: – Moscow: Medicine. – 1996. – 688 p.

7. A. A. Timofeev, Guidance on maxillo-facial surgery and dental surgery: – Kiev: “Chervona Ruta-Turs” LLC. – 2004. – 1062 p.: ill.

8. A. A. Timofeev, Maxillo-facial surgery: textbook / O. O. Tymofieiev. – Kiev: VSV “Medicine”, 2011. – P. 512

9. V. A. Khvatova, Clinical gnathology: – Moscow: Medicine. – 2005. – 312 p.