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Rakhimov Zokir Kayimovich, Khamitova Firuza Artikovna, Kambarova Shakhnoza Alihuseynovna, Pulatova Shahzoda Karimovna, Bukhara State Medical Institute, Department of Surgical Dentistry E-mail: dr.khamitova@mail.ru
COMPLEX TREATMENT OF PAIN DYSFUNCTION SYNDROME OF TEMPORОMANDIBULAR JOINT
Abstract
Research objective: is to increase quality of diagnostics and treatment of patients with a pain dysfunction syndrome of temporomandibular joint by the choice of diagnostic and medical actions.
Material and Methods: 172 patients with a syndrome of pain dysfunction of temporomandibular joint have been under the survey. All patients have been examined according to the scheme including subjective, objective and express methods.
Results: of the research allowed revealing that at 30% of patients the syndrome of pain dysfunction of temporomandibular joint has been caused by disk dislocation. Upon termination of the treatment which has been carried out by the scheme, the normalization of relationship of joint elements has been observed.
Conclusion: when the diagnosis of syndrome of pain dysfunction of temporomandibular joint is proved, it is necessary to apply complex treatment.
Keywords: temporomandibular joint, pain dysfunction syndrome, complex treatment.
Introduction: two periods - dysfunction TMJ and a painful spasm of chew-
Actual problems of modern dentistry are timely diagnos- ing muscles. Disease can begin both with the first, and since tics and treatment of a widespread pathology of maxillofacial the second period. However patients with SPD TMJ address
area - a syndrome of painful dysfunction temporomandibular joint (SPD TMJ). SPD TMJ has set of names: painful dysfunction TMJ, miofascial painful syndrome of face, dysfunction syndrome of TMJ, temporomandibular dysfunction, etc. Absence of a common opinion about an origin of the given disease, the combination of several symptoms and their inconstancy complicate diagnostics.
Symptoms of diseases TMJ meet at 35-55% of adult population. The majority of potential patients address to dentists concerning a syndrome of painful dysfunction TMJ. Thus sights at an etiology and pathogenesis the given clinical display are rather inconsistent that is one of the reasons of difficulty of diagnostics and treatment. At the same time anato-motografic features temporomandibular complex, complexity innervation, irradiation pains in various departments of an oral cavity, face, a head and a neck. Partly these circumstances it is possible to explain that differential diagnostics and, hence, accurate differentiation of a syndrome of painful dysfunction of this joint and others orofascial painful syndromes is rather not idle time for practical doctors. A large number of works are devoted to the diagnosis of diseases, but the basic methods till now remain clinical. In a clinical picture of disease allocate
to dentist in search of the decision of problems with a pain in maxillofacial area in the period of a painful spasm of chewing muscles, i.e. miofascial painful syndrome (MPS) more often. One of the diseases provoking the occurrence SPD TMJ, the dislocation of an intraarticulate disk TMJ which represents displacement of a disk from a surface of an articulate head and its jamming between elements TMJ is. Spasm of chewing muscles, especially lateral pterygoid muscles, the emotional and physical overstrain, stressful situations lead to functions of chewing muscles and further to a disk dislocation. In an etiology of a dislocation of a disk the trauma of articulate fabrics that is observed in the presence of premature contacts on separate teeth, non-uniform elusive occlusion off surface and other infringements tooth-jaw systems has great value.
The purpose: improvement of quality of diagnostics and treatment of patients with a syndrome of painful dysfunction TMJ by a choice of volume of medical events on the basis of an estimation of functional infringements tooth-jaw system and a general condition of patients.
Material and methods: The analysis of results of diagnostics and treatment of 105 patients with a syndrome of painful dysfunction TM is carried out the joint, arrived on
Section 5. Medical sciences
base of chair of surgical dentistry of Bukhara state medical institute in department of maxillofacial surgery of the Bukhara regional versatile medical centre, from them of 85% of women and 15% of men at the age from 19 till 48 years. All patients surveyed under the scheme including subjective, objective and special methods (studying of diagnostic models, oc-clusiograph, registration of movements of the bottom jaw, a computer tomography, electromyography). At collection of the anamnesis and survey of patients with complaints to pains in the field of chewing muscles and TMJ excessive mobility of the bottom jaw that is shown in the form of wide opening of a mouth at yawning, nibble the big piece of food etc., as a rule, is determined.
Diagnostic models studied an anthropometrical method. Estimated teeth, tooth alignments, a bite kind, occlusion contacts. Determine the direction of displacement of mandible, character occlusion a curve, super contacts, the sites causing blocking of movements of the mandible. Occlusiography conducted to all patients in central, forward and lateral occlusions for character studying closing teeth and tooth alignments.
For this purpose applied templates from basic wax which received by means of our device. At all patients registered movements in three directions: vertical, sagittal and transversal. Registration of movements was conducted from position central occlusion - for revealing of premature contacts of teeth-antagonists and, with is minimum separated tooth alignments,- for revealing of changes in elements TMJ and chewing muscles. Spiral computer tomography (SKT) conducted on spiral multiline tomography. Analysis SKT on sagittal reconstruction in position "a mouth is closed" conducted under the scheme. On sagittal reconstruction in position "the mouth is opened" studied structural changes and an arrangement of an articulate head in relation to articulate tubercle, degree of a disposition of a head of the bottom jaw. After carrying out of inspection at 30% of patients with a syndrome of painful dysfunction TMJ was the dislocation of an intraarticular disk TMJ is revealed. These patients have divided on two groups: control (25 persons) and the basic (37 persons). In control group of patients treated by the standard technique which included oral cavity sanitation, massage of chewing muscles, miogymnastics, alignment of the occlusal plane, rational prosthetics. Patients of the basic group treat by our technique.
Results: On the basis of the data received at inspection of 62 patients with a syndrome of painful dysfunction TMJ, the disk caused by a dislocation, have revealed the most typical complaints: a clicking arising suddenly at opening of a mouth on 2-3sm, restriction of opening of a mouth; a pain at lowering of the bottom jaw. Prescription of the beginning of disease at 74% of patients from 1 till 5 years, only 26% have addressed for the help on 2-7 day after the first blocking of a joint.
From the anamnesis founds out that 100% of patients repeatedly had a sensation of an obstacle in TMC at movements of the bottom jaw. Revealed at 82% of patients long unilateral chewing and bad habits prevailed. Stressful situations tested 5% of patients with a hypertonus of chewing muscles. The mental disturbances which have provoked a dislocation of a disk, diagnosed at 3% of patients. At objective inspection: opening of a mouth with deviation at 10% of patients; with defluxion in the sick party at 90%. Intact dentition observed at 57% of patients; partial absence of teeth at 43%, thus with secondary deformation of occlusion at 25%. Orthognathic bite 87% of patients had deep incisal overlapping of 13%. At palpation TMC and lateral pterygoid muscles on the amazed party have revealed a pain at all surveyed. Diagnostic models and oklyuziogram have revealed supracontacts in lateral occlusion at 64% of patients, in a lobby at 21% with vertical moving of teeth and at 15% of patients with intact dentition. At 100% of patients the amplitude of movements of the bottom jaw in contact to teeth-antagonists in the healthy party was less rates in 4 times and in the patient on 11.1%, forward on 24.4%; with is minimum separated tooth alignments in the healthy party there is less than rate on 27.6%, and in the patient of all on 12.6%, forward on 24.2%. On the basis of it is possible to draw a conclusion that in a joint there is a mechanic obstacle - the blocked disk limiting movements. According to a computer tomography, in slanting and face-to-face projections at 86% of patients with a dislocation of an intraarticular disk in position "the mouth is closed" and "the mouth is opened" contours of articulate surfaces accurate, equal, destructive changes of a bone fabric is not revealed and in 14% have found out morphological changes osteogenic joint elements. In complex treatment of such patients reasonably restriction of movement in a joint so that the head of the bottom jaw rotated on the longitudinal axis in relation to a disk and sliding of a head with a disk on a back slope was articulate tubercle minimum. One of the methods, allow to achieving it, the medical gymnastics is. Before mastering of all exercises of employment 3-4 times a day are conducted by the instructor or the doctor. Then the patient carries out exercises independently and number of employment lead up to 5-8 times a day. However curative measures not always are acceptable for the patient as demand a significant amount of free time, discipline and "cycling" of the patient on accomplishment of certain installations. Besides, for restriction of degree of opening of a mouth variety of orthopedic adaptations and designs is offered, however all of them have essential lacks. At electromyographic (EMG) researching in 86% of patients with a dislocation of a disk, changes of actually chewing and temporal muscles have not found out. After diagnosis confirmation start treatment. In comparison group (25 persons) patients treated by the stan-
dard technique which included oral cavity sanitation, massage of chewing muscles, alignment occlusion plane and rational prosthetics. Patients of the basic group (37 persons) conducted complex treatment. For pain and spasm elimination in lateral pterygoid muscle to all patients entered anesthetic solution. After anesthesia performed manual disk reposition. For this purpose it was necessary to rise behind the patient, a thumb of the right hand to establish on chewing surfaces of the bottom lateral teeth and other fingers on a body of the bottom jaw on the defeat party. Asked the patient to keep the bottom jaw in the weaken condition. With vibrating movements additionally weakened chewing muscles, took away the bottom jaw downwards and in the healthy party. These manipulations repeated until the disk returned in physiological position. Control was, free opening of a mouth without deviation (defluxion); plural contacts between teeth-antagonists. Thus eliminated the dislocation of the disk in 26% of patients, who applied on the first day (till 3 days), after disease origin. For relapse prevention diseases to patients recommended to limit lateral motions of the bottom jaw, to keep to a diet (acceptance of soft food) and to carry out myogymnastics within 2-3 months, for others 74% were prescribed a course of anesthesia (on 10 to the sick party in 1 day). Reposition conducted by the technique described earlier. After the tenth session of
anesthesia and manual repositions of 70% of patients have solute physiological position of a disk, but 4% of patients did not manage to be made it, and they have been directed on a surgical treatment. Besides, to all patients recommended physiotherapeutic procedures (drug electrophoresis, laser therapy, massage of parotid-chewing area on 10 sessions). After treatment patients were on control survey (in 1, 3 and 6 months). 96% received a positive result.
Conclusion:
Being based on the data of inspection of 175 patients with a syndrome of painful dysfunction TMJ, to 62 patients the diagnosis has been exposed: "the Dislocation of an intraarticular disk of TMJ", 37 from them have appointed complex treatment. In the beginning conducted anesthesia lateral pterygoid muscles. In the first visiting normalization of mutual relations of articulate elements was recovered by 26% of patients. From 3 to 10 sessions it was required for reposition of a disk of 70% of patients. Simultaneously all have appointed myogymnas-tic and physiotherapy, 56% of patients have conducted the selective grinding. Sedative preparations have appointed 5% of patients, antidepressants and neuroleptics under supervision of the psychotherapist of patients of 3%. For prevention of relapse of disease recommended keeping to a diet, to limit opening of a mouth and regularly to conduct myogymnastics.
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