Method of treating dental patients with chewing musculature dysfunction

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely dentistry, and aims at treating the patients suffering chewing musculature dysfunction. The 4 types of the chewing muscle state are pre-specified: type 1 - optimal state, type 2 - adaptive compensatory hypertrophy, type 3 - pathological hypertrophy, type 4 - functional decompensation. If observing the type 2 dysfunction, the patient is exposed to current pulses of frequency 15-30 Hz and intensity 8-10 mA. If observing the type 3 dysfunction, the exposure is characterized by frequency 40-60 Hz and intensity 5-8 mA. If observing the type 4 dysfunction, the exposure has pulse frequency 30-40 Hz and intensity 3-5 mA. The therapeutic sessions for the patients suffering the types 2 and 3 are conducted once a day for 15 min. The length for the patient suffering the type 4 dysfunction is 25 min; total number of the sessions is 5-10. The patient is exposed to percutaneous electric stimulation generated by Electronica EPB 50.01 apparatus.

EFFECT: method enables reducing the length of rehabilitation of the patients suffering the chewing musculature dysfunction ensured by selecting percutaneous electric stimulation modes for various types of dystonias.

 

The invention relates to medicine, namely to the dentist, and can be used in the treatment of dysfunction of the masticatory muscles.

According to literature data, dysfunction of masticatory muscles suffer from 5 to 85% of the population (Cross & Mathews, 1986; N. Widgorovicz-Manowerowa, 1979; Lindvist, 1974; R.Jankelson, 2002; Ouhadi, 1996; V.n.trezubov, 2004; Crankin, 2008). The basis of violations of muscle functions are changes in the contractile processes in the muscles (Himmler, 2006). Dysfunction of the masticatory musculature leads to the development of generalized forms of periodontitis, increased abrasion of hard tooth tissue, complicating decreasing the height of the bite and painful dysfunction of the temporomandibular joint (Vasilakos, 1998). After dental treatment, patients often continue to complain about the discomfort, stress and pain in the muscles, there is a breakage and deformation of orthopedic designs.

There are a large variety of methods of treatment of dental patients with dysfunction of the masticatory muscles. These include drug therapy, manual therapy, acupuncture, orthotic therapy and physiotherapy. The proposed method relates to physiotherapy treatment.

To develop more effective treatment was carried out a more thorough diagnosis of patients with varying degrees of defeat Givat the selected muscles, the classification of different types of pain syndromes and methods of treatment for each type of patient.

In the research process were examined 367 patients, of whom 142 men, 225 women, aged 29 to 60 years. To diagnose disorders has been reported following methods were used: clinical-anamnestic, radiation, comprising orthopantomography. We also used instrumental methods of research, in particular, to determine the ratio of the jaws were used spacecraft AIO", was conducted surface electromyography of the masseter and temporal muscles, muscles of the floor of mouth, neck and shoulder girdle, gadodiamide, myotonometry, infrared thermometry, programs, psychological testing.

After determining the clinical, functional and electrophysiological criteria dysfunction of the masticatory muscles in the examined dental patients we identified 4 types of state of the masticatory muscles.

Table 1
The functional state of actually chewing and temporal muscles.
TypeNumber of patients (n)Functional status The physiological meaning of state
1264OKOptimal state
243HypertonicityAdaptive compensatory hypertrophy
337HypertonicityPathological hypertrophy
423GipotonusFunctional decompensation

Violation of muscle tone was observed in patients 2, 3, and 4 types. Violation of muscle tone is a neuromuscular pathology and is positioned as one of the components of the pain response.

In patients with 1 type response of the masseter muscle on the functional load identified included defects of dentition, missing teeth not more than 2 months, also in this group includes previously prosthetic patients and patients with increased abrasion of hard tooth tissue to 1/4 the height of the crown.

In patients with type 2 response of the masseter muscle on the functional load identified and included leaf defects of dentition, loss of teeth from 2 D. who 6 months ago increased abrasion of hard tissues of teeth evenly, not more than 1/3 the height of the crown, generalized periodontitis to moderate severity.

In patients with 3 type of response of the masseter muscle on the functional load clinically observed included and limit the defects of dentition, loss of teeth from 6 months to a year and a half, increased uneven abrasion of hard tooth tissue in combination with periodontitis of moderate severity.

In patients with 4 type response of the masseter muscle on the functional load clinically observed included and leaf defects, loss of teeth more than 2 years ago, uneven abrasion of hard tooth tissue more than 1/2 crowns, severe periodontitis severity.

There are several methods of treating and relieving pain in dental patients. One of them is physiotherapy using devices pulse current of different frequencies.

In the method according to patent No. 2167679 from 23.03.2000, the treatment of the pain syndrome in the dysfunction of the temporomandibular joint conduct current of supersonic frequency TC (22 kHz) at an amperage of 3-5 mA, increasing to 2-3 μa through the procedure. The impact of the current conducted on the area of the TMJ and masticatory muscles. The General course of 10-12 daily procedures. Additionally carry out the oscillation TMJ with increasing intensity before going urogenitaaltrakti mobilization with simultaneous elimination of the functional blocks in the vertebral motor segments of the cervical spine. Physiotherapeutic effect is supplemented by exercises and massage of the masticatory muscles.

Such treatment is characterized by a duration and a large amount of procedures that require efforts on the part of both patient and doctor.

In the patent for invention №2197293 from 8.06.2001, (prototype) for the treatment of pain disorders and inflammatory and degenerative diseases of the temporomandibular joint a method of electrical stimulation pulse modulated current region of the temporomandibular joint, masticatory muscles and neck muscles. Additionally affect digastric muscle submandibular region and the trapezius muscle in the interscapular region, and the impact on the latter alternating with the impact on the sternocleidomastoid muscle. Electrical stimulation is carried out by a pulsed current with asymmetric bipolar pulse shape with a trapezoidal envelope with a frequency of 100-150 Hz and continuous form parcels. Current thus determined by the individual feel a light vibration. The exposure time gradually increase from 5 to 20 minutes on the course. The course is 14-15 daily procedures. The method is also characterized by the complexity and duration of the procedures.

In addition, in both treatments were similar for patients with different types of dysfunction of the masticatory muscles, which has effectively reduced Yunosti treatment.

In the present invention solved the problem simplify treatment and improve patient outcomes.

To solve the problem in the treatment of dental patients with dysfunction of the masticatory muscles, based on dermal effects on muscles pulsed current, exposure is carried out with a dysfunction of the 2nd type of current pulses with a frequency of 15-30 Hz and the power of 8-10 mA, with dysfunction of the 3rd type of pulses with a frequency of 40-60 Hz, power 5-8 mA, with dysfunction of the 4th type pulses 30-40 Hz, power 3-5 mA.

Healing sessions for patients with dysfunction of the 2nd and 3rd types carried out 1 time a day for 15 min for patients with dysfunction of the 4th type 25 min, when the total number of sessions 5-10 times.

For treatment sessions analgesic use the device "electronics APB".

The proposed treatment significantly easier known and more efficient due to selective recruitment frequency and current pulse effect in various types of dysfunction.

Analgesic device "electronics APB" recommended by the Commission on the physiological instruments and medical equipment Ministry of health of Russia (minutes No. 3 dated may 15, 1985) This device was intended for transcutaneous electroneurostimulation and is used for the treatment of pain syndromes of different origin and removal of mysen the th strain. As a result of use of the instrument creating optimal conditions for complex activation of immune function, including decreased pain sensitivity, improved emotional status of the patient, muscle relaxation, as well as the normalization of autonomic processes. However, this device was not used for the treatment of pain syndromes of the masticatory muscles.

The apparatus generates a bipolar current pulses of variable frequency, amplitude and duration. Comes with small electrodes made of special rubber specifically for oral and maxillofacial region.

There are two mechanisms of the effect of transcutaneous electroneurostimulation (enss). The first mechanism is that the touch input is realized by a thick afferent fibers, stimulates brake interneurone in the posterior horns of the spinal cord, blocking the transmission of pathological activity. The second mechanism is that of peripheral pulses excitatory neurons of the Central gray allowedprogram substances. In response to this stimulation increases the production of endorphins, increases their penetration into the plasma and cerebrospinal fluid and at all levels decreases pain transmission.

The authors have investigated different modes of operation of the apparatus for obtaining most effective the CSO impact in the treatment of atrophy of masticatory muscles. During the research it was revealed that the impact of tens differently in different functional States of the masticatory muscles and depends on the frequency of the pulse current and pulse duration.

Treatments were carried out as follows. Patients were divided into two groups. One control group received no treatment by tens. In the treatment of another group of patients was used treatment by percutaneous electrical nerve stimulation (tens). When treatment CHENS negative electrode was applied to the area of the tragus of the ear of the patient, and the positive electrode was fixed on the most protruding part of the chewing muscles. Further included analgesic device "electronics industrial safety examinations 50.01" and set the mode corresponding to the type of dysfunction, which was previously diagnosed in the patient. To monitor the stages of treatment using different instrumental methods of examination: electromyography, gadodiamide, Doppler.

In patients with physiological hypertrophy of the masticatory muscles (type 1) muscle hypertonicity was shot 3 weeks after the imposition of temporary structures made taking into account the structural relation of the jaws. When replacing the permanent design muscle tone again increased, but the muscle was synchronous and symmetrical, the label CHENS was not required.

For patients with hypertrophy of the 2nd type is the greatest treatment effect was detected when using the tens pulses with a frequency of 15-30 Hz and amperage 8-10 mA, for 15 minutes, 1 time a day. Depending on the condition of hypertonicity session was repeated 5-10 times, at least once in 2 days. Hypertonicity disappeared after a week. The control group of patients of this type, which have not been applied CHENS, hypertonicity disappeared 3 months after implantation. 6 months after implantation in all patients of this group dysfunction of the masticatory muscles was not found.

For patients, the 3rd type with pathological hypertrophy of the muscles in the presence of hypertonic treated with pulses of tens with a frequency of 40-60 Hz amperage 5-8 mA. After imposition of a temporary prosthetic construction muscle tone was increased, but the muscles remained synchronous and symmetrical. During examination after 3 weeks of dysfunction of the masticatory muscles was not revealed, but the performance of the assay using gadodiamide were higher than the original. After imposition of a permanent prosthetic design on electromyogram noted hypertonicity of muscles, which required re-tens in the number of 5-6 sessions. After 6 months of dysfunction of the masticatory muscles were not found.

For the control group of patients with pathological hypertrophy of the muscles of the 3rd type, to the x CHENS were not applied, after the imposition of temporary structures they complained about the fatigue in the muscles, discomfort in the TMJ area, was observed in depressive syndromes. For their elimination was conducted comprehensive treatment involving specialists in adjacent fields indicated. Dental treatment was carried out in stages, with the manufacture of trays, temporary structures. In all phases of dental treatment, according to the electromyographic examination, increased muscle tone. Rehabilitation has gone from 5 months to a year.

Of the 12 patients with masticatory muscles were in a state of functional decompensation (4th type) and who were treated at the adjacent specialists without the use of stimulation, to date there is no complete case. Of the 13 patients of the same group, which were treated tens, completed treatment 7 patients. Treatment lasted from one year to one and a half years. By reducing the tone of the masticatory muscles used frequency 30-40 Hz, amperage 3-5 mA. It is established that all patients tone muscles was increased by treatment stages slowly and consistently.

Thus, the proposed algorithms for the treatment of patients with various disorders of muscle tone. Selected modes of action of tens for different types of disorders of muscle tone. Achieved simplification and reduction in the time medical procedures. Podtverzhdennost treatment and proven when using transcutaneous electroneurostimulation in treatment of dental patients with dysfunction of the masticatory muscles accelerate the rehabilitation of these patients.

1. A method of treating dental patients with dysfunction of the masticatory muscles, including percutaneous effect on the muscles of the pulse current, wherein the pre-identify 4 types of state of the masticatory muscles: 1st type - optimal, 2-nd type - adaptive compensatory hypertrophy, the 3rd type of pathological hypertrophy, 4th type - functional decompensation; dysfunction of the 2nd type of masticatory muscles of the influence exercised by current pulses with a frequency of 15-30 Hz and the power of 8-10 mA, with dysfunction of the 3rd type of pulses with a frequency of 40-60 Hz, power 5-8 mA dysfunction 4 the second type of pulses 30-40 Hz, power 3-5 mA.

2. The method according to claim 1, characterized in that the treatment sessions for patients with dysfunction of the 2nd and 3rd types carried out 1 time a day for 15 min for patients with dysfunction of the 4th type 25 min, when the total number of sessions 5-10 times.

3. The method according to claim 1, characterized in that for carrying out treatments used analgesic device "electronics industrial safety examinations 50.01".



 

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