半导体激光治疗正畸患者颞下颌关节紊乱病

目的探讨半导体激光治疗正畸患者颞下颌关节紊乱病的效果。方法选择正畸患者合并颞下颌关节紊乱病患者28例，采用半导体激光治疗，应用Fricton指数定量评定表分别评定治疗前、后的颞下颌关节功能状况。结果治疗后颞下颌关节功能障碍指数（DI）、肌肉压痛指数（PI）和Friction指数（CMU评分较治疗前明显降低。结论半导体激光治疗正畸儿童颞下颌关节紊乱病能有效地缓解疼痛，改善颞下颌关节功能状况。     

RW-splint治疗前后患者颞下颌关节间隙的变化

目的:探讨RW-splint治疗颞下颌关节紊乱病(temporomandibular disorder,TMD)患者后颞下颌关节间隙的改变.方法:选取18例有临床症状的TMD患者,采用RW-splint进行治疗,治疗前、后用锥形束CT(CBCT)对患者双侧颞下颌关节扫描,测量颞下颌关节上、前、后、内、外侧间隙,分析髁突位置变化.结果:RW-splint治疗后患者颞下颌关节上、后、内侧间隙变宽,前、外侧间隙变窄,但以上变化差异均无统计学意义(P＞0.05).结论:RW-splint治疗使髁突发生向前、向下、向外移动趋势,改善髁突位置可能是RW-splint治疗TMD的生物学机制之一.     

内窥镜手术治疗颞下颌关节紊乱病的临床研究

目的评价关节内窥镜手术治疗颞下颌关节紊乱病的临床效果.方法应用关节内窥镜通过镜下各种微型手术器械,内窥镜直视下手术,通过灌洗、粘连松解、清扫等方法去除关节腔内各种病变和关节盘复位术,治疗113例(132侧关节)颞下颌关节紊乱病.结果随访6～84个月,随访期内,张口度增加0～16mm,平均9.6mm(P＜0.001),健侧侧向运动度增加2.5～7.8mm,平均4.8mm(P＜0.01);术后91.4%的患者疼痛缓解,疼痛缓解程度1.5～5.0,平均3.6(P＜0.001).62.5%的患者弹响消失.总的疗效评定为优良50例(44.2%),改善52例(46.0%),无效11例(9.7%),总有效率为90.3%(102/113).术后无严重并发症发生.结论内窥镜手术治疗颞下颌关节紊乱病是一种有效的方法.     

慢性继发性头痛或口面部疼痛

本文介绍了世界卫生组织(WHO)国际疾病分类-11(international classification of diseases-11,ICD-11)中有关慢性继发性头痛和慢性口面部疼痛的诊断标准,该标准主要参考国际头痛学会(Interna-tional Headache Society,HIS)发布的第3版国际头...     

颞下颌关节紊乱病的MRI表现与疼痛关系的研究

[目的]研究颞下颌关节紊乱病(TMD)的MRI表现与颞下颌关节疼痛的关系,探讨MRI在TMD诊断和治疗中的价值.[方法]对30例具有疼痛主诉的TMD患者的60侧颞下颌关节(TMJ)行开、闭口冠状位和矢状位T1加权、T2加权和质子加权扫描.[结果]MRI观察到37个疼痛关节中,发现关节盘移位34个(91.9%),关节盘变形33个(89.2%),关节渗液31个(83.8%);23个非疼痛关节中,关节盘移位12个(52.2%),关节盘变形3个(13%),关节渗液1个(4.5%).经统计学分析,疼痛与关节盘移位、变形和关节渗液的出现有关系(P＜0.01).[结论]MRI能清楚显示TMJ关节盘及周围组织变化,能反映TMJ的变化与疼痛的关系,在TMD的诊断和治疗方面均具有重要价值.     

颅面部疼痛与心肌缺血的相关性

目的 评估颅面部疼痛是否可以是心肌缺血的唯一症状,以及由心脏起源的颅面部疼痛的发生率、分布情况和性别差异.方法 连续选取到我院急诊室就诊并已证实有心肌缺血的患者186例,评估是否存在颅面部疼痛.对存在颅面部疼痛的患者研究其疼痛位置、放射区域及疼痛的细节.结果 71例(38%)在心肌缺血时感觉到颅面部区域疼痛;女性的发生率高于男性(P=0.031).11例(6%)颅面部疼痛是心肌缺血过程中的唯一症状,其中3例为急性心肌梗死(AMI).结论 颅面部疼痛可由心肌缺血引起,并且可以是心肌缺血的唯一症状,这一点必须在对牙痛和口面部疼痛的诊断时被考虑到.     

颌间牵引力对成年大鼠髁状突核因子kB受体活化因子配基/骨保护素的调控

背景:颌间不对称牵引是正畸中调整下颌位置和咬合关系的常规手段,常用于成人偏颌畸形的代偿性矫治.牵引力对成年颞下颌关节的影响尚存在争议.目的:创建下颌骨单侧前上牵引的大鼠动物模型,验证颌间牵引力大小不同对髁状突软骨下骨核因子kB受体活化因子配基/骨保护素表达的影响是否一致.设计、时间及地点:随机分组设计,对照动物实验,于2005-03/2007-03在四川大学口腔生物医学工程教育部重点实验室完成.材料:3月龄雄性SD大鼠180只分为对照组(n=20)、重力组(n=80)和轻力组(n=80).方法:在160只SD大鼠左侧眼眶前下方4 mm左右做平行于眼睑的切口以暴露颧弓,在左下颌角附近下唇下方1 cm,距离腹部中线5 mm处做另一切口.用镍钛拉黄连接固定左侧下颌角和同侧颧弓前部,用测力计确定其伸长所产生的力值为实验所需拉力值(40 g或120 g),28 d后撤除镍钛拉簧.对照组大鼠同样进行于术但不放置弹簧.主要观察指标:加力3,7,14,28 d及撤除外力后3,7,14,28 d,以免疫组织化学半定量检测双侧髁状突软骨下骨中核因子kB受体活化因子配基/骨保护素表达.结果:骨保护素在大鼠髁突软骨全层均有表达,软骨下骨、肥大带浅层和部分成熟软骨细胞表达较强.核因子kB受体活化因子配基在大鼠髁突软骨的全层均有表达,成熟的软骨细胞表达较强.与对照组比较,轻力组加力侧核因子kB受体活化因子配基的表达在前3 d明显升高(P<0.01),第7天表达量恢复正常水平,到14 d以后出现第2个高峰(P<0.01),撤除外力后3～7 d核因子kB受体活化因子配基表达量又再次升高(P<0.01),直到撤力14 d才开始回落.除了第7天外,重力组核因子kB受体活化因子配基表达比轻力组强烈(P<0.01).在28 d内,轻重力对骨保护素表达影响不明显.加力侧骨保护素表达在第3天没有明显变化,7 d表达量减少(P<0.01),到14 d以后出现第1个高峰,撤除外力后3 d骨保护素表达量又再次下降(P<0.01),直到撤力后7 d才出现第2个高峰.轻力和重力组大鼠加力侧髁状突核因子kB受体活化因子配基/骨保护素比值没有相关性(r=0.005,P>0.05).结论:轻、重牵引力作用对软骨下骨中骨保护素表达的量和变化规律是一致的;同时,核因子活化受体核因子kB受体活化因子配基对应力反应的表达曲线形态基本一致.     

下颌神经阻滞结合微波治疗颞颌关节紊乱病

目的:了解下颌神经阻滞结合微波治疗颞颌关节紊乱病(简称TMJD)的疗效与安全性。方法:选择诊断明确的单侧TMJD初诊病人50例,随机分成下颌神经阻滞组和对照组(单纯微波组),每组各25例,下颌神经阻滞组行患侧下颌神经阻滞1次/4天,治疗3~5次;配合每日一次局部微波治疗。对照组每日两次局部微波治疗。两组微波治疗均进行15~20天。结果:下颌神经阻滞组治愈16例(64%),好转5例(20%),显效4例(16%),无效0例,平均显效时间1.5±0.8天。对照组治愈10例(40%),好转4例(16%),显效10例(40%),无效1例(4%),平均显效时间6.1±1.3天。半年复发率下颌神经阻滞组4例(16%),对照组13例(52%)。经统计学处理,两组间治愈率和半年复发率有显著性差异(P<0.05)。两组病例均未发现明显不良反应。结论:下颌神经阻滞结合微波能有效提高TMJD的治愈率,缩短显效时间,降低复发率。     

针刺联合半导体激光治疗颞下颌关节紊乱病的疗效观察

目的 观察针刺联合半导体激光治疗对颞下颌关节紊乱病的影响。 方法 将56例颞下颌关节紊乱病患者按随机数字表法分为对照组和观察组,每组28例。2组患者均接受半导体激光治疗,观察组在此基础上联合针刺治疗,每周3次,持续3周。治疗前和治疗3周后（治疗后）,采用疼痛视觉模拟评分法（VAS）和Fricton颞下颌关节紊乱指数,对2组患者的疼痛程度和颞下颌关节功能开展评定。 结果 2组患者治疗后的VAS评分、DI、PI、CMI均较组内治疗前显著下降,且观察组治疗后VAS评分［（0.93±1.41）分］、DI（0.08±0.09）、CMI（0.05±0.06）较对照组低（P＜0.05）。2组患者治疗后PI比较,差异无统计学意义（P＞0.05）。治疗后,观察组的治疗总有效率（96.43%）高于对照组（78.57%）,差异有统计学意义（P＜0.05）。 结论 针刺联合半导体激光治疗可有效减轻颞下颌关节紊乱病患者的疼痛程度,改善颞下颌关节功能。     

颞下颌关节疾病患者合垫治疗的护理

【】目的：探讨颞下颌关节紊乱病治疗的整体护理对策, 总结相关护理体会。方法：回顾性总结2009 年9月至2013 年10 月期间我院收治的427例合垫治疗颞下颌关节紊乱病患者的护理工作及相关要点。结果：将合垫治疗后恢复正常盘髁关系者定为治疗成功,反之则为失败。结果显示,427 例患者414例治疗成功; 8例治疗失败,关节盘移位没有改善或盘移位进一步恶化;5例患者中途放弃治疗。总的有效率达到96.96%。结论：护理工作是整个医疗的保障,良好的护理能充分调动患者的主观能动性,创造利于治疗和康复的最佳身心状态;也可使患者得到高质量、高水平且安全舒适的服务与治疗。     

Use of the ID Migraine questionnaire for migraine in TMJ and Orofacial Pain Clinic

OBJECTIVE: The aim of this study was to determine whether the ID Migraine questionnaire could be applied successfully to assess the migraine patients in TMJ and Orofacial Pain Clinic. BACKGROUND: As migraine pain represents a substantial personal and social burden worldwide, there has been a great deal of effort in developing a screening instrument for migraine. METHODS: Each subject completed a self-administered screening questionnaire consisting of nine items. Based on the International Headache Society criteria, the clinical diagnosis of migraine was assigned. The sensitivity and specificity of the individual items were evaluated. An analysis of the data was performed using the SAS (Statistical Analysis System) V8.01. RESULTS: This study found that nausea, photophobia, and headache-related disability had the highest individual sensitivities and specificities, and the performance of the three-item screener was equivalent to that reported in a previous study. Although the sensitivity of the three-item screener in this study (0.58) was lower than in a previous study (0.81), the specificity (0.98) was higher and the positive predictive value was 93.9%. This suggests that the ID Migraine questionnaire is relatively efficient in this setting. CONCLUSION: The ID Migraine questionnaire, which is a three-item screener consisting of nausea, photophobia, and headache-related disability, could be used as a self-administered report for detecting migraine headaches in patients with temporomandibular disorders and orofacial pain.     

The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis

Background

Orofacial pain of myofascial origin is often associated with temporomandibular joint dysfunction, affects chewing muscles and may lead to functional limitations. Dry needling is an intervention commonly used for inactivating myofascial pain trigger points.

Alterations in pain processing circuitries in episodic migraine

BackgroundThe precise underlying mechanisms of migraine remain unknown. Although we have previously shown acute orofacial pain evoked changes within the brainstem of individuals with migraine, we do not know if these brainstem alterations are driven by changes in higher cortical regions. The aim of this investigation is to extend our previous investigation to determine if higher brain centers display altered activation patterns and connectivity in migraineurs during acute orofacial noxious stimuli.MethodsFunctional magnetic resonance imaging was performed in 29 healthy controls and 25 migraineurs during the interictal and immediately (within 24-h) prior to migraine phases. We assessed activation of higher cortical areas during noxious orofacial heat stimulation using a thermode device and assessed whole scan and pain-related changes in connectivity.ResultsDespite similar overall pain intensity ratings between all three groups, migraineurs in the group immediately prior to migraine displayed greater activation of the ipsilateral nucleus accumbens, the contralateral ventrolateral prefrontal cortex and two clusters in the dorsolateral prefrontal cortex (dlPFC). Reduced whole scan dlPFC [Z + 44] connectivity with cortical/subcortical and brainstem regions involved in pain modulation such as the putamen and primary motor cortex was demonstrated in migraineurs. Pain-related changes in connectivity of the dlPFC and the hypothalamus immediately prior to migraine was also found to be reduced with brainstem pain modulatory areas such as the rostral ventromedial medulla and dorsolateral pons.ConclusionsThese data reveal that the modulation of brainstem pain modulatory areas by higher cortical regions may be aberrant during pain and these alterations in this descending pain modulatory pathway manifests exclusively prior to the development of a migraine attack.     

Not only headache: higher degree of sexual pain symptoms among migraine sufferers

Chronic illness and chronic pain can have profound negative effects on relationship and sexual satisfaction, yet the influence of migraine on sexuality has not been previously evaluated. To assess sexual functions in subjects with migraine compared to those with no migraine. We evaluated female university students using the Israeli sexual behavior inventory (ISBI). Migraine was diagnosed according to self-reported symptoms according to the IHS criteria. Several dimensions of female sexuality—desire, orgasm, sexual avoidance, interpersonal sexual relationship, health influence, satisfaction and pain were evaluated using a structured questionnaire. Thirty-three (23.9%) of the participants met the IHS criteria for episodic migraine with and without aura. Sexual activity, desire, orgasm and satisfaction from sexual life did not differ significantly between migraine sufferers and non-sufferers. Migraine patients reported lower ISBI scores, higher health influence on sexual life, higher levels of sexual pain and lower sexual satisfaction. Migraine negatively affected the sexual life of sufferers. Sexual pain disorder is more common among migraine sufferers compared to non-migraineurs.     

Orofacial pain symptoms: an interaction between age and sex

This study investigated sex and age cohort differences in the subjective report of orofacial pain symptoms in a stratified sample of community dwelling adults. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults, age 45 and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites using a standardized telephone interview. The results suggest that the 6-month prevalence of jaw joint pain (8.3%), face pain (3.1%), toothache pain (12.0%), painful oral sores (15.6%), and burning mouth (1.6%) found in the FDCS sample are similar to United States population estimates. In addition, prevalence for pain when chewing and temperature sensitivity were also reported as 23% and 24% respectively, suggesting that these two seldom documented painful experiences are common. Female respondents reported higher 6-month prevalence for multiple symptoms and painful oral sores, with trends also observed for female sex as a risk factor for jaw joint pain and face pain, whereas males were more likely to report temperature sensitivity. A higher percentage of females rated their pain as severe enough to impact behavior for jaw joint pain, toothache pain, and painful oral sores. Few overall age effects were found, with the exception of higher prevalence of temperature sensitivity and pain when chewing in the 45–64-year-old group, compared to respondents in the 65+ age cohort. However, the most interesting finding was that when sex by age cohort comparisons were made, with the exception of painful oral sores, all significant differences in pain ratings were found within the 45–64-year-old cohort and not the 65+ group. This finding clarified inconsistencies found in earlier studies in the orofacial pain literature where sex differences in pain ratings were found in several adult samples of a wide range of ages but not in a sample of older adults.     

Comparison of glutamate-evoked pain between the temporalis and masseter muscles in men and women

Pain in myofascial temporomandibular disorder (TMD) can affect both the masseter and temporalis muscles. Glutamate injection into the masseter muscle evokes pain that is greater in men than in women and this pain is attenuated by co-injection of the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine (10 mmol/L) in men. Animal studies suggested that pain induced by peripheral NMDA receptor activation could differ between the temporalis and masseter muscles and between men and women. The study aims were to investigate differences in glutamate-evoked pain between these muscles and the effectiveness of ketamine to attenuate glutamate-evoked pain in both genders. Pain and mechanical sensitivity were induced in 2 sessions of an experiment in 14 women and 16 men by repeated injections of glutamate (0.5 mol/L) with and without ketamine (20 mmol/L) into the masseter and temporalis muscles. Two injections were applied into the same masseter muscle and 2 injections into the same anterior temporalis muscle at each session. Visual analogue scale (VAS) pain intensities and pain drawing areas were assessed. Glutamate-evoked pain and pain drawing area were significantly greater from the temporalis muscle than from the masseter muscle (P<.02) in both genders. Women reported significantly greater glutamate-evoked masseter muscle pain than men (P<.03). Co-injection of ketamine, at higher dose than previously used, was equally effective in attenuating glutamate-evoked pain from both muscles in both genders (P<.01). The current findings indicate that the characteristics of pain generated by intramuscular injection of glutamate vary for different masticatory muscles and may be partially generated through activation of peripheral NMDA receptors.     

Mammography-related breast pain is associated with migraine

There is little information about the perception of experimentally induced extracephalic pain in migraine. This study investigates the associations between mammography-related pain and migraine. A neurologist clinically assessed 630 women aged 40–74 years attending a population-based breast cancer screening programme. Headache criteria proposed by the International Headache Society were used. Mammography-related pain was measured on a 100-mm visual analogue scale. High levels of mammography-related pain were associated with migraine. This association was related to mammographic examination during the early follicular phase and menopausal status, but unrelated to differences in age, compression pressure, education, current use of hormonal replacement therapy, anxiety, and recent use of analgesics and antimigraine medication. The results of the present study indicate that migraine and compression-induced breast pain are related.     

Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind,randomized, controlled clinical trial

ObjectivesThis study evaluated the effects of low-power laser auriculotherapy (LA) on the physical and emotional symptoms of patients with temporomandibular disorders (TMDs), in comparison with occlusal splints (OS).DesignRandomized, blinded, prospective, non-inferiority clinical trial.InterventionsThe patients received OS (control group) or LA (experimental group).Main outcome measuresFollowing the Consolidated Standards of Reporting Trials (CONSORT) guidelines, patients with TMD were evaluated by using axes I and II of the Research Diagnostic Criteria for RDC-TMD. Both intra- and intergroup quantitative variables were analyzed with ANOVA (p < 0.05), while qualitative variables were analyzed with the Kruskal–Wallis (intergroup evaluations; p < 0.05) or Mann–Whitney tests (intragroup analyses; p < 0.05).ResultsOS improved five physical symptoms of TMD (pain in the right temporal muscle, right and left masseter muscles, left joint, and left intraoral region), while LA improved six (jaw functioning; pain in left masseter muscle, right and left joints, and right and left intraoral regions). Similarly, OS improved seven emotional symptoms (degree of depression, degree of non-specific physical symptoms, excluding pain, degree of non-specific physical symptoms including pain, average pain value in the past 6 months, presence of depression, intensity and characteristics of pain, non-specific physical symptoms including pain), while LA improved five (degree of non-specific physical symptoms including pain, presence of depression, intensity and characteristics of pain, non-specific physical symptoms including pain, non-specific physical symptoms excluding pain).ConclusionLA improved the physical and emotional symptoms of TMD, with results similar to OS.Clinical relevanceFor the physical and emotional symptoms associated with TMD, LA showed similar outcomes as OS.     

Validation of the eleven-point pain scale in the measurement of migraine headache pain

The four-point pain scale (none, mild, moderate, severe) and the 11-point pain scale (0 = no pain, 10 = pain as bad as it could be) have been used in migraine studies to assess treatment efficacy. The primary objective of this study was to investigate the validity and responsiveness of the 11-point pain scale using the four-point pain scale as a benchmark. Using data from 95 migraine patients recruited from headache clinics, this study found that 11-point pain scale scores were highly correlated with four-point pain scores. The correlations between the pain scales were significantly higher than the correlations with quality of life measures such as functional ability and emotional feelings. The 11-point pain scale was 55% more sensitive than the four-point pain scale in detecting clinically important differences. The strong linear relationship between the two pain scales allowed researchers to transform four-point pain scores to 11-point pain scores using regression weights.