咬合的增龄性变化及其临床诊疗与防治策略

Age-Related Changes in Occlusion and the Clinical Management and Prevention Strategies

摘要

咬合是指上下牙之间的接触关系，其生物力学特征可影响口颌面颈等部的运动功能以及精神心理状态。本综述从正常咬合的功能特点及其增龄性变化、异常咬合对健康的影响及其可能的神经生理学机制、咬合的增龄性变化及其对策这3个方面介绍咬合的增龄性变化及其临床诊疗与防治策略。咬合面的异常磨损将导致咬合生物力学关系发生变化，动物实验研究表明，异常咬合可造成：（1）牙周创伤；（2）通过三叉神经中脑核神经元与三叉神经运动核、面神经核、副神经核、舌下神经核、迷走神经背核等神经核团的运动神经元之间的突触联系，导致口颌面颈肌功能障碍以及迷走神经相关的内脏运动功能异常；（3）通过影响外侧僵核神经元的活动，导致焦虑等精神心理反应。口腔修复体与天然牙之间存在磨耗系数差异，长期佩戴口腔修复体，可增加天然牙与人工牙之间磨损不匹配进而出现咬合干扰的风险。牙体磨损是增龄性咬合变化最常见的表现，一些老年患者不仅有错、缺牙、修复体，而且常伴有牙周病，缺牙久未修复还可出现邻牙倾斜、对颌牙伸长等渐进性咬合紊乱，在这些错、牙周病以及缺牙相关问题的基础上叠加增龄性磨损，不仅可增加异常咬合对健康的影响程度，而且会增加治疗难度。为此，对于错和牙周病，应重视早期诊断、早期治疗，以预防进入老年期后出现矫治非常困难的局面；对于缺牙应及时修复，防止出现继发性咬合紊乱；对于口腔修复体，应关注材料的选择和修复体力学关系的设计，避免使用过硬的材料修复缺牙，避免形成干扰性咬合接触，并应定期更换修复体，以降低与生理性磨损不均相关的咬合问题及其继发性健康问题。

Abstract

Occlusion refers to the contact relationship between the upper and lower teeth. Its biomechanical properties influence motor function, most often in the orofacial and cervical regions, and the patient’s psychological well-being as well. In this review, we summarized age-related changes in occlusion and the corresponding clinical management and preventive strategies from three perspectives-the functional characteristics of normal occlusion and their age-related changes, the effects of abnormal occlusion on health and the potential neurophysiological mechanisms involved, and age-related changes in occlusion and the corresponding preventive and therapeutic approaches. Abnormal wear of the occlusal surfaces alters the biomechanical relationship of occlusion. Animal studies have shown that abnormal biomechanical occlusion may result in the following problems: 1) periodontal trauma; 2) dysfunction of the orofacial and cervical muscles and vagus nerve-related visceral motor dysfunction through synaptic connections between neurons in the mesencephalic trigeminal nucleus and motor neurons in the trigeminal motor, facial, accessory, hypoglossal, and dorsal vagal nuclei; and 3) psychological responses such as anxiety, mediated via effects on neuronal activity in the lateral habenular nucleus. The wear coefficients of dental restorative prostheses differ from those of natural teeth. Long-term use of dental prostheses increases the risk of wear mismatch between natural and artificial teeth, which may lead to increased risk of occlusal interference. Tooth wear is the most common manifestation of age-related changes in occlusion. In addition to malocclusion, missing teeth, and pre-existing prostheses, many older patients also present with periodontal disease. Prolonged failure to replace missing teeth may lead to progressive occlusal disturbances, characterized by tilting of adjacent teeth and elongation of opposing teeth. When age-related wear is superimposed on malocclusion, periodontal disease, and missing teeth, it not only exacerbates the adverse health effects of abnormal occlusion but also substantially complicates treatment. Therefore, early diagnosis and treatment of malocclusion and periodontal diseases are essential to the prevention of situations where orthodontic intervention becomes extremely challenging in old age. Missing teeth should be restored promptly to prevent secondary occlusal disorders. For dental prostheses, careful attention should be paid to material selection and biomechanical design. Excessively hard materials should be avoided to prevent the development of interfering occlusal contacts. In addition, prostheses should be replaced regularly to reduce occlusal problems arising from uneven physiological wear and the associated secondary health consequences.

关键词

咬合 / 增龄性变化 / 口腔功能 / 牙齿磨耗 / 防治 / 综述

Key words

Occlusion / Age-related changes / Oral function / Tooth wear / Prevention and treatment / Review

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