Edentia – the total or partial absence of teeth arising owing to their loss or anomaly of development of zubochelyustny system. The edentia is characterized by violation of a continuity of tooth alignments, functions of chewing and the speech, cosmetic defect; in hard cases - deformation of a facial skeleton, VNChS diseases, further loss of teeth. Diagnosis of an edentia is carried out by the specialist stomatologist by means of visual and palpatorny inspection, an aim intra oral rentgeyonografiya, an orthopan-tomography. Treatment of an edentia consists in performing rational prosthetics by means of partial or full removable artificial limbs or dental implantation.
Edentia - primary or secondary defect of tooth alignments which is characterized by lack of separate or all tooth units in an oral cavity. The edentia in stomatology is considered as a special case of anomaly of number of teeth, along with a giperodontiya (accessory teeth) and a gipodontiya (reduction of their number on a sravneyoniya with norm). The full congenital edentia meets exclusively seldom; prevalence of a partial edentia among zubochelyustny anomalies at children makes about 1%. The partial secondary edentia is found in 45-75%, and full - at 25% of people 60 years are more senior. The edentia is not only esthetic defect, but also is followed by considerable violations of functioning of zubochelyustny system, a GIT, deterioration in an articulation and diction, psychological disadaptation, change of social behavior of the person.
Classification of an edentia
Depending on the reasons and time of emergence distinguish primary (congenital) and secondary (acquired) edentia, and also an edentia of temporary and second teeth. In the absence of a tooth rudiment speak about a true congenital edentia; in case of merge of the next crowns or a delay in terms of a teething (retention) – about a false edentia.
Taking into account the number of missing teeth the edentia can be partial (there are no teeth) and full (there are no all teeth). The partial congenital edentia is understood as absence to 10 teeth (usually top side cutters, the second premolyar and the third painters); lack more than 10 teeth is classified as a multiple edentia. As criterion of a partial secondary edentia serves absence on one jaw from 1 to 15 teeth.
In practice of orthopedic stomatology classification of a partial secondary edentia by Kennedy who allocates 4 classes of defects of tooth alignments is used:
- I – existence of bilateral trailer defect (distalno unlimited defect);
- II – existence of unilateral trailer defect (distalno unlimited defect);
- III – existence of the unilateral included defect (distalno limited defect);
- IV – existence of the frontal included defect (lack of foreteeth).
Each class of a partial secondary edentia in turn is divided into a number of subclasses; besides, defects of various classes and subclasses are often combined among themselves. Also distinguish a symmetric and asymmetric edentia.
Absence or death of rudiments of teeth is the cornerstone of primary edentia. At the same time primary edentia can be caused by the hereditary reasons or develop under the influence of the harmful factors operating during formation of a tooth plate at a fruit. So, laying of rudiments of temporary teeth occurs on 7-10 weeks of pre-natal development of a fruit; second teeth - after the 17th week.
Full congenital edentia – extremely unusual occurrence which usually takes place at a hereditary ektodermalny dysplasia. In this case, along with an edentia, at patients the underdevelopment of skin, a hair, nails, grease and sweat glands, nerves, crystalline lenses of eyes etc. Krom of hereditary pathology is usually noted, primary edentia can be caused by a rassasyvaniye of tooth rudiments under the influence of teratogenny factors, endocrine failures, infectious diseases; violations of mineral exchange in the pre-natal period, etc. It is known that death of tooth rudiments can happen at a hypothyroidism, an ichthyosis, a hypophysial nanizm.
As the reason of a secondary edentia serves loss of teeth by the patient in the course of activity. Partial lack of teeth usually is a consequence of deep caries, a pulpitis, periodontal disease, periodontitis, removal of teeth and/or their roots, injuries of teeth, odontogenny osteomyelitis, a periostit, perikoronarit, abscess or phlegmon etc. Incorrectly carried out therapeutic or surgical dental care (a root top resection, a tsistotomiya, a tsistektomiya) can sometimes act as the reason of a secondary edentia. In case of the untimely orthopedic help the partial secondary edentia promotes progressing of process of loss of teeth.
Symptoms of primary edentia
Primary full edentia meets as in a dairy, and constant bite. At a full congenital edentia, except lack of tooth rudiments and teeth, as a rule, there is a violation of development of a facial skeleton: reduction of the sizes of the lower part of the person, underdevelopment of jaws, sharp expressiveness of a supramentalny fold, flat sky. The nezarashcheniye of fontanels and bones of a skull, not union of maxillofacial bones can be noted. At an angidrotichesky ektodermalny dysplasia the edentia is combined with angidrozy and gipotrikhozy, lack of eyebrows and eyelashes, pallor and dryness of mucous membranes, early aging of skin.
The patient with primary full form of an edentia is deprived of an opportunity to bite off and chew food therefore it is forced to eat only liquid and soft food. As the investigation of an underdevelopment of the nasal courses serves the mixed roto-nasal breath. Violations of the speech are presented by multiple violation of a sound pronunciation at which the articulation of lingual and tooth sounds appears the most defective ([t], , [N], [with],  and their soft couples, and also a sound [ts]).
Reduction of quantity () of teeth in a tooth alignment is the main sign of partial primary edentia. Between the next teeth trema are formed, there is a shift of the next teeth to the area of tooth deyofekt, there is an underdevelopment of jaws. At the same time antagoniruyushchy teeth can settle down densely, out of a tooth alignment, be heated up at each other or remain impacted. At an edentia in forward group of teeth the interdental pronunciation of the whistling sounds is noted. Trema and the wrong position of teeth can lead to development of the chronic localized gingivit.
Symptoms of a secondary edentia
The secondary edentia in a dairy or constant bite is a consequence of loss or removal of teeth. In this case integrity of tooth alignments is broken after eruption of the created teeth.
At total absence of teeth the expressed shift of the lower jaw to a nose, a zapadeniye of soft fabrics of prirotovy area, formation of multiple wrinkles is noted. The full edentia is followed by a considerable reduction of jaws – in the beginning osteoporosis of alveolar shoots, and then and jaw bodies. Often there are painless ekzostoza of a jaw or painful bone ledges formed by edges of holes of teeth. Also, as well as at primary full edentia, food is broken, the speech suffers.
At a secondary partial edentia the remained teeth gradually are displaced and disperse. At the same time in the course of chewing the raised loading while on sites of an edentia similar loading is absent that is followed by destruction of a bone tissue is the share of them.
The partial secondary edentia can be complicated by pathological erasability of teeth, a giperesteziya, pain at a smykaniye of teeth, influence of any mechanical or thermal irritants; formation of pathological desnevy and bone pockets, angulyarny heylita. At a considerable partial edentia there can be a habitual incomplete dislocation or dislocation of a temporal and mandibular joint.
Cosmetic defects at an edentia are characterized to changes of a face form, the expressed nasolabial folds, a podborodochny fold, omission of corners of a mouth. In case of absence of group of frontal teeth "zapadeniye" of lips is noted; at defects in side teeth – hollowness of cheeks.
Patients with an edentia often have gastritises, stomach ulcer of a stomach, colitis in this connection it is required to them not only the help of the stomatologist, but also gastroenterologist. Loss of teeth is followed by decrease in a self-assessment of the person, psychological and physical discomfort, change of social behavior.
Diagnosis of an edentia
The edentia is a problem in which diagnostics and elimination specialists stomatologists of various specialties take part: therapists, surgeons, orthopedists, orthodontists, implantologists, parodontolog.
Diagnosis of an edentia includes collecting the anamnesis, clinical examination, comparison of a chronological vozrasyot with tooth, palpatorny inspection. With local defect after terms of eruption of tooth for specification of the diagnosis the aim vnutrirotoyovy X-ray analysis is usually used. In case of a multiple or full edentia the panoramic X-ray analysis or an orthopan-tomography, if necessary a X-ray analysis or KT of a temporal and mandibular joint is carried out. X-ray inspection allows to reveal lack of rudiments of teeth, to find the roots covered with a gum, ekzostoza, oral cavity tumors, to estimate a condition of fabric of an alveolar shoot, inflammation signs, etc.
Treatment of an edentia
As the main method of elimination of an edentia serves prosthetics with use of fixed (bridge-like) orthopedic designs and removable dentures (byugelny, plastinochny). The choice of a method of treatment of an edentia is defined by the stomatologist-orthopedist taking into account anatomic, physiological, hygienic features of zubochelyustny system of the patient.
Fixed prosthetics at a full edentia assumes installation of basic dental implants (mini-implants) on which then the prosthetic design fastens. At a partial edentia as basic the intact or well healed teeth are used. Method of the choice of elimination of a secondary partial edentia is classical dental implantation with installation of a crown.
Treatment of children with a congenital edentia can begin with 3-4-year age. Orthopedic actions at full primary edentia come down to production of full removable plastinochny artificial limbs which at children have to be replaced for new each 1,5-2 years. Prosthetics by partially removable plastinochny artificial limb is shown also at primary partial edentia. Replacement of a removable artificial limb by bridge-like carries out only after the end of growth of jaws.
When using removable plastinochny artificial limbs there is a risk of development of prosthetic stomatitis, decubituses of desnevy fabrics, allergies to dyes and polymers of material of an artificial limb. Before starting treatment of a partial edentia carrying out full professional hygiene of an oral cavity, if necessary - complex treatment of caries, a pulpitis, periodontitis, a periodontal disease, elimination of a giperesteziya of teeth, removals of the roots and teeth which are not subject to preservation is required.
Prevention of an edentia
Prevention of a congenital edentia at the child provides favorable conditions for pre-natal development of a fruit, an exception of potential risk factors. At a delay of standard terms of a teething it is necessary to address the children's stomatologist.
The prevention of a secondary edentia comes down to regular routine dental inspections, holding hygienic actions, timely sanitation of the pathological centers in an oral cavity. In case of loss of teeth it is necessary to carry out prosthetics in order to avoid progressing of an edentia as soon as possible.