扁臉短吻貓的咬合創傷(occlusal trauma, trauma from occlusion or occlusal traumatism)

茫寶是一隻約兩歲的曼赤肯公貓，剛換完乳牙後不久，飼主偶然發現貓咪的口腔有不明紅色腫塊，位置就在兩側下顎的第一臼齒旁邊，飼主曾經嘗試讓茫寶進行手術切除、內科藥物等療程，但相同的位置又重複腫起，貓咪到後來甚至開始有吃飯速度變慢、甩頭、挖嘴巴等症狀，飼主遂在茫寶滿一歲時預約本院牙科門診，初診評估為咬合不正導致的咬合創傷（occlusal trauma, trauma from occlusion or occlusal traumatism），進而造成的創傷性肉芽腫(traumatic granuloma)病灶。
 
咬合創傷指的是由於不正常或過大的咬合力，導致牙周組織的發炎、紅腫及破壞，長期的發炎與刺激甚至可能會導致該處齒槽骨的流失、或是牙根部位的齒吸收（tooth resorption），而因為是異常咬合所致，內科藥物更不可能有實際的治療效果。

咬合創傷主要分為兩大類：
1.原發性咬合創傷(primary occlusal trauma)：因不正常或過大的咬合力，作用在原本健康的牙周組織，而造成的牙周組織傷害。
2.繼發性咬合創傷(secondary occlusal trauma)：病患因為牙周疾病導致牙周組織支撐牙齒的能力下降，無法承受原本的咬合力道，進而產生的咬合創傷型態。

 
茫寶是屬於原發性的咬合創傷，因為咬合不正，造成雙側下顎第一臼齒（309、409）頰側處的牙齦產生創傷性肉芽腫，治療上光是切除肉芽腫是不夠的，對咬的雙側上顎第四前臼齒（108、208）會因為咬合不正，導致其持續刺激肉芽腫切除的部位，進而反覆產生新的創傷性肉芽腫，在貓咪這類的案例不少，扁臉貓因為齒弓空間較不足、容易因空間擁擠造成咬合不正，發生咬合創傷的機率又更高。
 
在治療方面，調整咬合是最重要的治療準則。在本案例中，我修磨了108、208咬合面的尖端，讓下顎頰側牙齦不再受到刺激，搭配切除肉芽腫組織，最終解決了咬合創傷的問題，現在茫寶不會再無故甩頭、也不會再用手去撥嘴巴，主人也終於可以不用每個月定時帶貓來醫院報到了。
 
備註：該貓咪個案是右側頰側先發生咬合創傷，2021.05.22右側頰側治癒後，發現左側頰側緊接著出現相同的咬合創傷，至2021.09.10左側頰側治癒。
 
參考文獻：
Gracis, M., Molinari, E., & Ferro, S. (2015). Caudal mucogingival lesions secondary to traumatic dental occlusion in 27 cats: macroscopic and microscopic description, treatment and follow-up. J Feline Med Surg, 17(4), 318-328. doi:10.1177/1098612X14541264
Greenstein, G., Cavallaro, J., Scharf, D., & Tarnow, D. (2008). Differential diagnosis and management of flared maxillary anterior teeth. J Am Dent Assoc, 139(6), 715-723. doi:10.14219/jada.archive.2008.0253
 
  Mang-Bao is a two-year-old Munchkin male cat. Soon after he completed the growth of permanent teeth, the owner discovered that the patient’s mouth had an unidentified red bump (granuloma), they were next to the first molars of the mandibular on both sides. The owner had tried many kinds of treatments, such as surgical removal of granulomas and various medicines, but the same place was repeatedly swollen, the cat even began to have symptoms such as eating slowly, shaking head, mouth digging, etc., so the owner brought the cat to my hospital for the first time when the patient was one year old. At the first dental clinic, the patient was diagnosed with occlusal trauma (also called “trauma from occlusion” or “occlusal traumatism”) which was caused by malocclusion, and then this caused traumatic granulomas.
  Occlusal trauma refers to the inflammation, redness and destruction of periodontal tissue due to abnormal or excessive occlusal force. Long-term inflammation and irritation may even lead to the loss of alveolar bone or tooth absorption at the root of the tooth, and because it is caused by abnormal occlusion, medicines will not have a therapeutic effect.
  There are two types of occlusal trauma:
1. Primary occlusal trauma--periodontal tissue injury caused by abnormal or excessive occlusal force acting on the originally healthy periodontal tissue.
2. Secondary occlusal trauma--due to periodontal disease, the ability of the periodontal tissue to support the tooth is loss, and the patient is unable to withstand the original occlusal force anymore, resulting in occlusal trauma.
  Mang-Bao is a primary occlusal trauma patient. Because of the malocclusion, traumatic granulomas are produced on the gingiva of the first molars of the mandibular on both sides (309, 409). Resection of the granulomas is not enough for the treatment. The fourth premolars of the maxillary on both sides (108, 208) will continue to irritate the wound after surgery due to the malocclusion, and then repeatedly produce new traumatic granulomas in the original position. There are many pstients of occlusal trauma in cats, if the cat is a flat-faced breed, the insufficient dental arch space and are prone to malocclusion caused by crowded space, and the probability of occlusal trauma is higher than other breeds.
  Adjusting the occlusion is the most important point in treatment. In this patient, I polished the tips of the 108 and 208 morsal surfaces, so that the gingiva on the buccal side of the mandibular are no longer irritated. I also removed the granulomas at the same time, all problems of occlusal trauma are finally solved. Now Mang-Bao will no longer shake his head for no reason, never use his hands to dial the mouth again. The owner finally doesn’t need to bring him to my hospital every month.
 
Remarks: In this patient, occlusal trauma occurred first on the right buccal side. After the right buccal side was healed on May 22, 2021, the same occlusal trauma was found on the left buccal side, and finally healed the lesion on September 10, 2021.
 
References:
Gracis, M., Molinari, E., & Ferro, S. (2015). Caudal mucogingival lesions secondary to traumatic dental occlusion in 27 cats: macroscopic and microscopic description, treatment and follow-up. J Feline Med Surg, 17(4 ), 318-328. doi:10.1177/1098612X14541264
Greenstein, G., Cavallaro, J., Scharf, D., & Tarnow, D. (2008). Differential diagnosis and management of flared maxillary anterior teeth. J Am Dent Assoc, 139(6), 715-723. doi: 10.14219/jada.archive.2008.0253


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