occlusal disorder
Introduction
Introduction Tooth occlusion disorder: The occlusal relationship between the upper and lower teeth is often disturbed by the displacement of the jaw fracture. This is the most obvious symptom of the jaw fracture and is of great significance for the diagnosis of jaw fracture. The mandibular transverse fracture, the fracture segment is displaced downward, so that the maxillary posterior teeth and the mandibular posterior teeth are in early contact, so that the anterior teeth are in an open occlusion state. After the mandibular fracture, due to the displacement of the fracture segment, the occlusal relationship of the teeth is disordered. If there is no displacement of the fracture segment, there is no obvious confusion in the tooth occlusion.
Cause
Cause
The cause of occlusion is disordered. This disease is mostly caused by trauma. According to the cause of injury, it can be divided into two categories: firearm damage and non-firearm damage.
Examine
an examination
Related inspection
Occlusal relationship check
Clinical manifestations:
Compared with other fractures, jaw fractures have some common clinical symptoms, such as local pain, swelling, abnormal movement or displacement of the broken ends, dysfunction, etc., and also have their clinical features, which is the anatomy of the jaw. Determined by the physiological structure.
1. Dislocation of the fracture segment: The displacement of the fracture segment after the jaw fracture depends mainly on the type of fracture, the direction of impact, the muscle pull and the weight of the fracture segment itself.
If a transverse fracture occurs in the maxilla, the fracture segment often sags due to gravity. If the direction of impact is from front to back, the fracture segment can be displaced backwards to make the central part concave; the impact from the bottom to the top often causes the incarcerated fracture.
The displacement of the mandibular fracture segment is mainly caused by muscle traction. When the pupil is fractured, the anterior fracture segment is often displaced downward due to the traction of the descending muscle group, and the posterior fracture segment is often displaced upward due to the pulling of the jaw muscle group. In the comminuted fracture of the ankle, the middle fracture segment is displaced backward due to the pulling of the genioglossus and the genioglossus. The fractures on both sides are displaced to the midline due to the pulling of the mandibular lingual muscles and the hyoid bones, which narrows the arch of the anterior mandible. This kind of fracture can cause the tongue to fall back and cause breathing difficulties, and even suffocation, so special attention should be paid. Fractures of the condyle, caused by multiple receptors, can occur at the same time as the ankle fracture, should be checked to avoid missed diagnosis. After the condyle fracture, often due to the traction of the extra-pterygic muscle, the inner side is displaced, and the mandibular ascending branch is displaced upward due to the traction of the maxillary muscle group, and the anterior teeth cannot be closed. If the bilateral condyle fractures, the anterior teeth are more obvious.
2, tooth occlusion disorder: the occlusal relationship between the upper and lower teeth is often caused by the displacement of the jaw fracture segment, which is the most obvious symptom of the jaw fracture, which is of great significance for the diagnosis of jaw fracture. The mandibular transverse fracture, the fracture segment is displaced downward, so that the maxillary posterior teeth and the mandibular posterior teeth are in early contact, so that the anterior teeth are in an open occlusion state. After the mandibular fracture, due to the displacement of the fracture segment, the occlusal relationship of the teeth is disordered. If there is no displacement of the fracture segment, there is no obvious confusion in the tooth occlusion.
3, abnormal activity of the fracture segment: the maxilla is an inactive bone, if there is activity, it is a sign of fracture. The mandible is normally moved through the joint as a whole. In the case of segmental abnormal activity, there is a fracture.
4, abnormal feeling: in the fracture of the maxilla, if there is an injury to the infraorbital nerve, numbness may appear in the lower part of the lower jaw, upper lip and nose. When the mandible is fractured, such as associated with inferior alveolar nerve injury, the ipsilateral lower lip may have numbness.
5, limited mouth opening: after the jaw fracture, the mouth can be restricted due to pain, fracture segment displacement, masticatory muscle movement disorder and reflex stenosis, temporomandibular joint injury and other reasons. In particular, mandibular fractures have a greater impact on mouth movement.
6. Affecting breathing and swallowing: Jaw fractures can be displaced by the fracture segment, affecting breathing and swallowing function.
7. Visual impairment: The fracture of the maxilla and humerus affects the ankle. When there is eyeball shift, double vision may occur. In the case of oculomotor and muscle damage, eye movement disorders may occur.
Diagnosis
Differential diagnosis
Symptoms of occlusion and confusion:
Tooth occlusion is weak: periodontitis often manifests as bleeding gums, bad breath, overflowing pus, loose teeth, severe occlusion and persistent dull pain. Early symptoms are not obvious, and patients often have only episodes of gingival hemorrhage or bad breath, similar to sputum inflammation. At the time of examination, the swelling of the gingival margin, licking nipple and attached sputum, the softness of the sputum, the dark red or the dark red color, the bleeding is easy to detect.
Dislocation of teeth is misaligned: the clinical manifestation of crowded dentition is that the teeth are crowded and misaligned, mainly because the amount of teeth is larger than the amount of bone, and the shape of the arch is abnormal. The clinical manifestation is that the teeth are crowded and misaligned, mainly because the amount of teeth is larger than the amount of bone, and the shape of the arch is abnormal.
Large gaps in the teeth: It is because of the poor development of the teeth or the large gap between the teeth caused by the damage of the posterior teeth, which leads to eating teeth or affecting the appearance of the teeth. First, when the teeth are changed, the growth of the permanent teeth is deviated, and the unevenness of the growth leads to sparseness and large gaps. Second, the gums may not develop well. The gums are the basis of dental support. If malnutrition occurs, it may lead to poor tooth development.
Abnormal tooth structure: refers to the abnormal development of teeth caused by various obstacles during tooth development or matrix calcification during tooth development, and leaves permanent defects or marks on the tooth tissue. Common enamels are: Dysplasia, dentine hypoplasia, dental fluorosis and tetracycline staining teeth.
Loose teeth and shedding: refers to the loosening of the teeth caused by external impact, periodontal disease, gum atrophy, nutritional aging of the old gums, etc., causing tooth loss after severe. Most adults suffer from periodontal disease. Most periodontal diseases progress slowly. Most of them are gingivitis at the beginning. There are not many symptoms other than occasional brushing, so it is not noticeable. The development of gingivitis to a certain extent is periodontitis. At this time, severe oral odor can occur, the abscess is repeated in the periodontal period, the teeth are loose, the teeth are getting bigger and bigger, and the teeth are getting sparse. If the patient is seen at this stage, the doctor can control the deterioration of inflammation, but the damaged periodontal tissues (including gum atrophy) are irreversible and difficult to recover completely.
diagnosis:
Diagnosis of jaw fractures should first understand the cause of injury, the location of direct injury and the course of injury, and then check the local and full physical signs, with reference to the above clinical features, to determine whether there are fractures, fractures and types. When conditions permit, X-ray examination and CT examination can be further performed to understand the location, number, direction and displacement of the fracture line. It should be emphasized that the examination should be exhaustive, and the diagnosis of multiple injuries to the maxillofacial region and multiple injuries of the whole body should not be missed, so as to provide a sufficient basis for the development of a complete treatment plan.
There are three classic types of maxillary fractures based on weak points in the anatomy. The first type of fracture (Lefort type I fracture) has a fracture line that passes through the lower edge of the piriform hole, the lower part of the maxillary sinus, and traverses to the bilateral maxillary nodules. The fracture line of the second type of fracture (LeFort type II fracture) passes through the nasal bone and tear bone. , under the humerus, below the humerus, to the posterior wall of the maxilla; the fracture line of the third type of fracture (LeFort type III fracture) also passes through the nasal bones, tear bone, but across the armpit and tibia, back to the maxilla The wall separates the maxilla, the tibia and the skull, so it is also called craniofacial separation. The mandible is the only active bone in the head. It also has its weak parts in the anatomy, such as the median condyle, the pupil, the mandibular angle and the condylar neck. These are the predilections of the mandibular fracture. . The mandible is the most common bone in maxillofacial fractures due to its prominent position and anatomy.
