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Gnathologist. Gnathology in Kiev

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Each of us knows what toothache is. When it appears, it will be correct to consult a dentist and treat a tooth. However, it happens that there is pain but the dentist does not see defects and abnormalities in the teeth. Otherwise, a denture has been installed but it is uncomfortable to chew, sometimes even painful. In this case a gnathologist will help a patient.

It is necessary to visit this specialist if you have been looking for a long time and without result for the cause of headaches, because almost 90% of such cases are just pain caused by excessive tension of the masticatory muscles. You do not even realize that the cause of cervical osteochondritis may be hiding not in disorders of posture, diet or lifestyle, but in changes in the dentofacial system. In this case, an orthopedic gnathologist will also help you. Most of the patients of this specialist are people who make a prosthetic appliance for teeth at the moment, as well as patients who correct the abnormal bite.

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What is clinical gnathology?

From the course of anatomy in school, we know that the dentofacial system in humans, in addition to the jaws and the teeth as such, consists of many components. These are muscles, ligaments, nerves, bones, joints. The interaction of all these parts of the dentofacial apparatus is investigated by the science of gnathology. Moreover, it studies the interaction of the organs of the system under normal and pathological conditions.

It just seems that chewing is easy. In fact, for this process to occur correctly, you need a lot of components. The movements of the lower jaw are corrected by the strongest muscles in the body, the chewing ones. They are responsible for the movement of the jaw during chewing, breathing, talking, and even during sleep. The chewing surface of each of our teeth contains more than two dozen functional elements, any changes of which lead to problems in the chewing process.

Gnathology helps to make a prosthetic appliance for teeth properly, as well as to treat functional occlusion of the maxilla-temporal joint. In a nutshell, the knowledge helps a gnathologist find the physiological position of the patient's lower jaw so that the processes of breathing, chewing, swallowing and speaking are correct.

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Photo 1. The impression of the position of the mandibular bone of a patient suffering from headaches for 2 years as a result of improper prosthetics 

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Photo 2-3. Estimation of the respiratory tract during the diagnosis

The main task of gnathology is to find out why the jaw has been displaced, as well as to establish its correct position, and to return the organ to the position before displacement. This will remove the grinding and erasing of the teeth, clicks and pain in the joint, blocking up when chewing or yawning. Thus, all the functions of the dentition will be restored. Gnathology analyzes postural disorders, compares the data of the orthodontic situation and the functionality of the dentofacial system.

For a competent diagnosis, a gnathologist may opt to X-ray diagnostics or MRI of the TMJ.

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Photo 4-5. In the pictures you can estimate the position of the articular disc and correctly set the mandibular bone. An MRI scan is performed at the diagnostic stage

This allows to assess the position of the disc more accurately, in cases where the jaw "clicks", if you have a feeling of "stiffness" during eating, talking, or if you noted that the jaw "jammed."

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Photo 6. After setting a large number of fillings, discomfort appeared and the gums started to recess (see photo 2)

We visit a gnathologist

Each dentist applies knowledge of gnathology in the course of his work, for example, puts a dental filling so that the function of the joint is not disturbed. Dentist-gnathologist will look at the problem more widely. This specialist is able to reconstruct the oral cavity of the person accurately and in accordance with its anatomical features. Consultation with such a specialist is necessary if the patient complains of a crunch in the joint during chewing, pain in the masticatory muscles, restriction of movement of the lower jaw, aching pain in the maxilla-temporal joint.  Gnathologist treats the dislocations and subluxations of this joint, as well as its inflammatory diseases - arthritis and arthrosis.

Headache, dizziness, reduced visual acuity, problems that seem to have nothing to do with the dentofacial system, can also be treated by an orthodontist-gnathologist. The reason for making an appointment with this specialist can be tinnitus and hearing loss, pain in the teeth, shoulders or neck. All of these symptoms indicate dysfunction of the dentofacial system of the patient.

Knowledge of gnathology even helps remove wrinkles in the corners of the mouth that upset women so much. To do this, it is enough just to put the jaw in the correct position.

Frequent patients of the gnathologist are people with bruxism. Despite the seeming simplicity of the problem, this disease eventually leads to increased stresses on fillings and erasure of teeth. These people often have neurological problems: pain in the head, muscles and sleep disorders.

Consultation with a gnathologist is often needed for orthopedic and orthodontic treatment. Prosthetic dentistry works closely with gnathology. Indeed, for the formation of the anatomic bite, it is important to install the apparatus for correction extremely gently, paying attention to the state of the maxilla-temporal joint and masticatory muscles. Coherence in the jaw muscles depends on many factors. Only if you count on the surface of the bite between the teeth correctly, you can achieve the perfect correction of the abnormal bite. Therefore, if during his work the orthodontist faces the existing disorders of the maxillofacial apparatus, for example, a crunch in the joint, discomfort, tension, and even pain, he must refer the patient to a gnathologist in order to avoid mistakes during the installation of the correction apparatus. Only in this case the treatment will be successful.

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Photo 7. Diagnostic stage of gnathological treatment

Dentist will give a referral to a gnathologist if a person badly (indistinctly) bites, for example, his teeth are erased heavily. Or, in order to bite, he needs to make an effort to find a comfortable position.

Sometimes a patient cannot fully bite after a dental prosthetic rehabilitation. This means that the dentist was unable to determine the cause of improper biting. It happens that people with broken dentures are referred to gnathologist to put these dentures in the correct position as accurately as possible. This specialist should teach the patient to start biting properly. But before that, all dental canals should be treated, fillings should be put, and there should not be the soft tissues edema. Gnathologist will help an orthopedic dentist stabilize a patient’s state, get the teeth in the correct position and perform prosthetics without complications.

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Photo 8. During bite control, temporary prosthetics are used (white toothpaste). To check the bite, a carbon copy is used (the teeth are colored blue). The result of the treatment is anatomic bite on all teeth

How is treatment performed by a gnathologist?

During the first visit, this specialist will examine not only the teeth, jaw and joint. A good gnathologist also palpates all elements of the muscular-ligamentous apparatus above the collarbone, and even the back muscles. After all, problems with the correct operation of all components of the dentofacial system can "come to light" out of a sedentary lifestyle, physical inactivity. For example, the muscles and ligaments of the left shoulder suffer from frequent sitting at a computer in the wrong posture.

Before starting treatment, a gnathologist may ask you to do the check studies necessary for an accurate diagnosis. Most likely it will be cone beam computed tomography (CBCT) of the maxilla-temporal joint in different positions of the jaw. Also, the doctor may prescribe axiography - this is the definition of the trajectory of the joint head on the surface of the bones of the skull, as well as myography - the study of masticatory muscles. All these studies are necessary for gnathologist to determine the quality of the bite in two positions, first when moving, then without load, at rest and, accordingly, to make the correct diagnosis.

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Photo 9. Aligners for the diagnosis of bruxism

If during the studies it turns out that the issue is likely that the chewing system does not function well, the doctor will prepare a detailed treatment regimen. It may be necessary to consult related specialists: an ENT, a neurologist, or a surgeon. Depending on the specific situation, treatment with a gnathologist may take several hours or several weeks. If the situation is pronounced, then you may have to visit a doctor up to 6 times. After all, a doctor needs to collect, process and analyze a large amount of information, and only then outline in which direction the treatment will take place. But more often, only a couple of consultations of a gnathologist are needed: at the first, the doctor analyzes the situation and prescribes additional studies. At the second, he gives recommendations.

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Photo 10. In the photo there is a rigid aligner, which helps the mandibular bone to take the correct position

A gnathologist has bite aligners and trainers in his arsenal, and in their practice these specialists widely use special myogymnastics, which favours relaxation of the masticatory muscles. The set of exercises is selected individually for each patient. After a consultation with a gnathologist you will become attentive to what you bite.

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Photo 11. A deprogrammator is installed between the teeth (not visible in the photo, as it is behind the teeth), which is used for the differential diagnosis of bite problems or with TMJ

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Photo 12-14. Aligners to prepare for orthodontic treatment, and one of the aligner is installed in the patient's oral cavity. The main task of the splint is to help the orthodontist to correctly align the jaws

Reviews of patients indicate that this specialty is very popular. Unfortunately, an experienced gnathologist does not work in every dental or orthodontic clinic in Kiev. At the same time, even in the capital many people do not know where a gnathologist receives patients. If you Google it, of course, this information can be found in Internet. Self-respecting clinics do have such a specialist on staff. For example, the gnathologist Nazariy A. Brotskiy  in the Dubnova’s clinic “STOMATOLOGiYa” in Kiev is a “magic wand” for patients who were desperate to look for the cause of their ailments, who had been visiting many doctors and have already lost hope of getting rid of ailments. A visit to this specialist can be the beginning of a new life for them without pain, dizziness, tinnitus and other unpleasant consequences of disturbances in the work of the elements of the dentofacial system.