心理因素与颞下颌关节紊乱病的研究进展

心理因素在颞下颌关节紊乱病(TMD)发生发展以及治疗中的作用,一直是研究和争议的问题之一.本文对心理因素在颞下颌关节紊乱病的发生、发展和诊断治疗作用的研究进展作一综述.     

Occlusal risk factors for temporomandibular disorders

OBJECTIVE: To determine the role of occlusal variables (overbite; overjet; number of anterior and posterior teeth; bilateral canine guidance on lateral and protrusive movements; anterior centric slide; Angle Classes I, II, and III malocclusion) as risk indicators for the development of temporomandibular disorders (TMDs). MATERIALS AND METHODS: Seventy-two TMD patients with myofascial pain, with or without limited opening and arthralgia, as well as 30 age- and gender-matched pain-free concurrent controls were included. The association (critical odds ratio [OR] = 2.0) between the significant occlusal variables and TMD was calculated. Confounders were controlled in the inclusion-exclusion criteria as well as in the analysis stage (unconditional logistic regression) by variation in the OR (15%). RESULTS: Angle Class II malocclusion (crude OR = 8.0, confidence interval [CI] = 2.2 to 29.3) and the absence of bilateral canine guidance on lateral excursion (crude OR = 3.9, CI = 1.6 to 9.7) were statistically more common in patients than in controls. Spontaneous pain as well as pain on palpation (Class II or higher) were also statistically worse in TMD patients. Significant confounders (ie, employment, age, cigarette and alcohol consumption) acted as effect modifiers not changing the critical OR (adjusted OR Angle Class II and bilateral canine guidance = 8.3 to 12.4 and 2.2 to 4.1, respectively). CONCLUSIONS: Absence of bilateral canine guidance on lateral excursion and particularly Angle Class II malocclusion were considered important risk indicators for the development of TMD in this investigation, even when some sociodemographic factors were considered as effect modifiers.     

A critical review on the importance of psychological factors in temporomandibular disorders

Recent researches on temporomandibular disorders (TMD) have been focused on the interaction between physical and psychological factors. In this work, studies on the role of the latter have been critically reviewed and analysed. A number of works proved the existence of an association between TMD and anxiety, depression and stress, but none demonstrated causality of that relation. In consideration of that, debates are still open to discuss the possible predisposing, triggering and/or worsening role played by some psychic disorders in TMD subjects. Nevertheless, considering the usefulness of recent taxonomic proposals, it seems logical to adopt a broad therapeutic approach, directed both to the physical and psychic component of TMD symptoms. Besides, from this review it is underlined the need for controlled trials which, regardless of the causality of TMD-psychic disorders associations, definitively evaluate the efficacy of the various psychotherapy modalities proposed.     

心理因素与颞下颌关节紊乱病症状表现的相关性研究

目的:探讨焦虑和抑郁是否为罹患颞下颌关节紊乱病(TMD)的危险因素。方法:病例组为临床TMD患者,对照组为无TMD症状的健康人,采用焦虑症状自评量表(SAS)和抑郁症状自评量表(SDS)对心理因素进行评估。同时记录是否存在其他混杂因素,如习惯咬硬物、偏侧咀嚼、叩齿、夜磨牙、拔牙史等。采用Stata 11.0软件包对数据进行统计学分析。结果:共纳入200例样本,每组各100例,病例组SAS评分、SDS评分均显著高于对照组(P<0.05)。对不同严重程度焦虑倾向、抑郁倾向的OR进行趋势检验,均具有统计学意义。但logistic回归分析显示,患颞下颌关节紊乱病的危险因素中,仅焦虑倾向与偏侧咀嚼具有统计学意义(P<0.05)。结论:焦虑倾向与抑郁倾向为TMD相关的重要危险因素,随着其严重程度的增加,患TMD的危险性也增加。在混杂因素偏侧咀嚼存在时,只有焦虑倾向仍然是TMD的危险因素。     

Effect of hypnosis on oral function and psychological factors in temporomandibular disorders patients

Summary This study investigated the effect of hypnosis in patients with temporomandibular disorders (TMD) with focus on oral function and psychological outcomes. Forty women (mean age ± s.d.: 38·6 ± 10·8 years) suffering from TMD (mean duration 11·9 ± 9·9 years) were randomized to four individual 1‐hour sessions of either hypnotic intervention or a control condition of simple relaxation. Pain intensity was assessed three times daily on a 0–10 Numerical Rating Scale. Additional outcomes were TMD‐associated symptoms assessed by the Research Diagnostic Criteria examination form and questionnaire, psychological symptoms (Symptom Check List 60), pain coping strategies (Coping Strategies Questionnaire), sleep difficulties (Pittsburgh Sleep Quality Index) and use of analgesics. Data were analyzed with between‐groups within‐subjects anova s. The hypnosis group significantly reduced the daily NRS pain scores from 4·5 ± 2·1 at baseline to 2·9 ± 2·4 after treatment (P < 0·001) compared to the control group where no significant changes were found (4·2 ± 1·4 to 3·9 ± 1·5) (P = 0·733). Number needed to treat for a 50% pain reduction was 4·0. The hypnosis group also increased use of the coping strategy ‘reinterpreting pain sensations’ from 5·2 ± 6·9 to 10·3 ± 6·8 (P < 0·001). Both groups exhibited significant reductions in the number of painful muscle palpation sites and pain on palpation (P < 0·004), in number of awakenings due to pain (P < 0·006), and in somatization, obsessive compulsive symptoms and anxiety (P < 0·004). Hypnosis thus appears to effectively reduce some aspects of complex TMD pain.     

在校学生颞下颌关节紊乱病与心理因素关系的研究

目的:探讨心理因素对在校生颞下颌关节紊乱病(TMD)的影响.方法:对52例14～ 26岁确诊为颞下颌关节紊乱病(TMD)及53名健康在校生进行颞下颌关节紊乱病专科检查,并填写症状自评量表(SCL-90).患者组分为咀嚼肌功能紊乱(MD)组26例、关节盘移位(TD)组14例、关节盘移位咀嚼肌功能紊乱并存(MD+TD)组12例,按病程分为急性组32例(病史≤6个月),慢性组20例(病史＞6个月).用SPSS 17.0对各分组SCL-90总分及因子分进行比较分析.结果:TMD组SCL-90总分及各因子得分高于健康对照组(P＜0.05).MD组得分与TD组得分差异无统计学意义(P＞0.05),MD+ TD组的SCL-90总分及除抑郁、恐怖和精神病性外的其他因子得分显著高于前2组(P＜0.05).急性组躯体化得分高于慢性组(P＜0.05),其他项目2组差异无统计学意义(P＞0.05).TMD患者SCL-90总分与疼痛等级呈正相关关系.结论:心理因素对患TMD的在校生影响显著,可影响TMD相关疼痛的程度,对在校生的TMD进行治疗时应考虑心理的相关治疗.     

颞下颌关节紊乱病不同症状患者心理因素调查

目的研究颞下颌关节紊乱病（TMD）不同症状患者心理社会因素,尤其是焦虑的差别,为心理治疗对策提供试验依据。 方法206例就诊于天津医科大学口腔医院的TMD患者和201名无症状志愿者,填写症状自评量表（SCL-90）和状态-特质焦虑问卷（STAI）,根据患者主诉分组。采用SPSS 17.0统计软件,采用独立样本t检验和单因素方差分析对所有数据进行统计学分析。 结果（1）TMD患者SCL-90量表中的躯体化、抑郁、焦虑、敌对、精神病性因子得分及总分高于无症状志愿者,差异有统计学意义（t_躯体化 = 3.79,P_躯体化 = 0.000;t_抑郁 = 2.14,P_抑郁 = 0.033;t_焦虑 = 2.91,P_焦虑 = 0.004;t_敌对 = 3.93,P_敌对 = 0.000;t_精神病性 = 2.48,P_精神病性 = 0.013;t_总分 = 2.80,P_总分 = 0.005）;女性TMD患者的状态焦虑及特质焦虑得分均高于女性无症状志愿者（t_状态焦虑 = 3.52,P_状态焦虑 = 0.001;t_特质焦虑 = 4.26,P_特质焦虑 = 0.000）,两组男性之间差异无统计学意义（t_状态焦虑 = 0.36,P_状态焦虑 = 0.718;t_特质焦虑 = 0.76,P_特质焦虑 = 0.453）;（2）不同症状TMD患者在躯体化和状态焦虑方面差异有统计学意义（F_躯体化 = 2.714,P_躯体化 = 0.046;F_特质焦虑 = 3.007,P_特质焦虑 = 0.031）,具有单纯疼痛症状者躯体化得分高于单纯弹响患者（P = 0.005）,单纯弹响及疼痛伴弹响患者的特质焦虑得分高于疼痛伴开口受限者（P = 0.016）。 结论TMD患者心理健康水平比无症状人群低,主要表现在躯体化、抑郁、焦虑、敌对和精神病性方面。女性TMD患者有明显焦虑特征。单纯疼痛TMD患者躯体化比单纯弹响者更为明显。     

大学生颞下颌关节紊乱病与心理因素相关性的研究

目的:探讨大学生中颞下颌关节紊乱病(TMD)与心理因素的关系.方法:以在校大学生为目标人群,选取400例作为研究对象,进行初步筛查,再从中选出TMD患者和正常人各30例进行对照研究,对所得数据进行统计学分析.结果:大学生TMD患病率56.68%(212/374).病例组和对照组90项症状自评量表(SCL-90)的总均分...     

颞下颌关节紊乱病的心理因素的研究

目的：探讨心理因素在颞下颌关节紊乱病(TMD)发病机制中的作用。方法：采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和明尼苏达多项人格量表(MMPI)对颞下颌关节紊乱病患组和正常对照组各30例进行调查。结果：TMD患组与对照组相比，具有较高的焦虑和抑郁得分；MMPI测试结果显示，在MMPI十项临床量表中，患组在其中的疑病(HS)、抑郁(D)、癔病(HY)、精神病态(PD)、精神衰弱(PT)、精神分裂(SC)、社会内-外向(SI)七项中得分均高于对照组。另外，患组有26例临床量表中的一项或多项得分高于常模分数，说明TMD患的人格有偏离现象。结论：颞下颌关节紊乱病患的情绪障碍以及人格特征在其发病机制中具有重要作用。     

109例颞下颌关节紊乱病相关因素分析

目的:探讨颞下颌关节紊乱病的相关危险因素,为临床预防提供帮助.方法:将2016年1月-2016年6月就诊于深圳市第二人民医院口腔科,并被诊断为颞下颌关节紊乱病者109例纳入病例组,随机抽取109名正常人作为对照组,进行问卷调查.使用SPSS 22.0软件包中的逻辑回归分析模型对调查结果进行统计学分析.结果:病例组中女性患者占76.1％,20～29岁年龄组患者最多,占44％.病例组中有夜磨牙或紧咬牙习惯、偏侧咀嚼习惯、颌面部外伤史的人数比例显著高于对照组(P＜0.05);经常熬夜、工作生活压力大、咀嚼硬物、有正畸治疗史的人数比例在病例组与对照组间无显著差异(P＞0.05).结论:年轻女性为颞下颌关节紊乱病的高发人群;夜磨牙或紧咬牙习惯、偏侧咀嚼习惯、颌面部外伤史可能是颞下颌关节紊乱病的重要危险因素;未见经常熬夜、工作生活压力大、咀嚼硬物、正畸治疗史与颞下颌关节紊乱病明显相关.     

Emotional factors in temporomandibular joint disorders

The chronic pain of many temporomandibular disorders is associated with multiple changes in emotional function and activities of daily living. Temporomandibular disorders (TMD) are similar to other chronic pain disorders in their impact on patients. Depression is probably the most common emotional state associated with chronic pain, although anxiety disorders also can be associated with TMD. The probability of emotional problems appears to be greatest in those individuals diagnosed with myofascial pain and least in those with disk displacement. Dental practitioners are encouraged to seek professional liaisons with mental health professionals who can assist them in managing chronic pain patients.     

伴TMD的成人正畸患者心理健康状况调查与分析

目的:探讨伴颞下颌关节紊乱病(TMD)的成人正畸患者的心理健康状况。方法:应用90项症状清单(Self-reportingInventory,SCL-90)对42例伴TMD的成人正畸患者(实验组),50例无正畸需求的伴TMD的成人错人群(对照组)进行测试,结果进行t检验。结果:2组测试在强迫症状、抑郁、焦虑、偏执、人际关系敏感因素上得分高于全国成人常模(P<0.05)。实验组在强迫症状、抑郁、焦虑、人际关系敏感因素上得分与对照组有显著性差异(P<0.05)。结论:伴颞下颌关节紊乱病的成人正畸患者存在一定程度的心理问题。     

Association of risk factors with temporomandibular disorders in the Northern Finland Birth Cohort 1966

Objective: To investigate the association between risk factors and pain-related symptoms and clinical signs of temporomandibular disorders (TMD) in Northern Finland Birth Cohort (NFBC) 1966.

Material and methods: A total of 1962 subjects (1050 women, 912 men) attended the follow-up study. The questionnaires included the subjects’ background information concerning living conditions and general health, socioeconomic factors, and dental health. The clinical examination was performed using the modified protocol of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) presented at the International Association for Dental Research (IADR) Conference in 2010. Cross-tabulation, a chi-square test and Fisher’s exact test were used to analyze differences between groups.

Results: Female gender showed statistically significant association with symptoms and signs of TMD, while marital status, living conditions, and socioeconomic group showed no association. A strong association was found between self-reported health condition as well as general health problems [i.e. depression, migraine, fibromyalgia (FM), gastrointestinal diseases] and TMD pain-related symptoms and pain on palpation in the masticatory muscles and TMJs.

Conclusion: In conclusion, general health problems and female gender had a strong association with pain-related symptoms and clinical signs of TMD. These findings are important to take into account when diagnosing and treating TMD patients. Conversely to earlier presented results, no statistically significant association was shown here between marital status, living conditions or socioeconomic group and pain-related symptoms and clinical signs of TMD.     

Role of psychosocial factors on treatment outcome of temporomandibular disorders

Objectives: The aim of this randomized controlled study was to investigate the effect of depressive and non-specific physical symptoms on treatment outcome of temporomandibular disorders (TMD).

Material and methods: Eighty TMD patients were randomly assigned to splint group (n?=?39) and control group (n?=?41). The patients were classified in terms of depressive and non-specific physical symptoms as normal, moderate or severe using Research Diagnostic Criteria for Temporomandibular Disorders Axis II protocol. The effect of depressive and non-specific physical symptoms on the intensity of facial pain, as measured with visual analogue scale (VAS) was estimated with linear mixed models. The patients’ subjective estimates of the effects of treatment and TMD symptom severity were inquired at 1-year follow-up.

Results: At baseline and during the follow-up there were no significant differences in VAS scores between patients in different Axis II subscales. According to the mixed linear regression, depressiveness or nonspecific physical symptoms separately were not significantly associated with the VAS during the study. The association of VAS with depressive (p?=?.073) and nonspecific physical symptoms (p?=?.088) approximated statistical significance. Patients with moderate or severe nonspecific physical symptoms (with pain items) at baseline had more frequently moderate, severe or intolerable TMD symptoms after the treatment compared to those who were classified in normal subgroup.

Conclusions: The present study gave some indication of a possible negative effect of depressive and nonspecific physical symptoms (with pain items) on TMD treatment response. However, the results should be regarded as preliminary, and further studies with larger sample size are needed to confirm the results.     

Orthodontic risk factors for temporomandibular disorders (TMD). I: Premolar extractions.

Concern about claims that premolar extractions may put patients at risk for temporomandibular disorders (TMD) led to this study. We report first findings from a longitudinal study of orthodontic patients begun in 1983. By using the methods of Helkimo, we collected TMD data before initiation of orthodontic treatment, between 0 and 12 months after debanding, and 12 to 24 months after debanding. Analyses related Helkimo scores with premolar extractions in 65 patients for whom orthodontic treatment had been completed. Twenty-six patients were treated without premolar extractions, 25 had four premolars extracted, and 14 had two upper premolars extracted. Tests for significance of differences between mean Helkimo scores were conducted for the nonextraction group compared with the extraction groups, and between pretreatment and posttreatment Helkimo scores for each group. Results included: (1) no significant intergroup differences between mean pretreatment or posttreatment scores, and (2) small but statistically significant (p less than 0.05) differences (in the direction of improvement) between mean pretreatment and posttreatment scores for both the nonextraction group and for the four premolar extraction group.     

History factors associated with symptoms of temporomandibular disorders

Differences in prevalence of head or neck trauma, orthodontic treatment and molar oral surgery procedures reported by individuals were compared among patients with temporomandibular disorders (TMD) and with two comparison groups (a sample of asymptomatic individuals, and a sample with mild or early signs). Association to specific TMD symptoms was tested amongst the comparison groups. Trauma was the most significant factor characterizing TMD patients. History of trauma was also more common among those otherwise normal but symptomatic individuals in the non-patient comparison group. Specific TMD symptoms were significantly associated with history of trauma in the comparison group. Significantly more women TMD patients had a history of orthodontic and molar oral surgery treatment than the asymptomatic comparison group. History of orthodontics was also associated with the symptomatic sample of the comparison group in women, but it was not significantly related to any specific TMD symptoms. Symptomatic members of the comparison group could not be differentiated based upon history of molar oral surgery. Certain risk factors may have been delineated, but causal relationship of treatment requires study of co-existing and predisposing behavioural and structural factors.     

颞下颌关节紊乱病的心理社会因素研究

目的：探讨颞下颌关节紊乱病的心理社会因素。方法：犯人组共112例，大学生组共281例。采用MMPI进行问卷调查，同时进行颞下颌关节紊乱病调查，按Helkimo指数进行分析。结果：犯人组临床量表中疑病（Hs)、精神病态（Pd)和妄想（Pa)明显高于国内常模。大学生组为正常人格。结果显示，较严重的既往功能紊乱和临床检查功能紊乱患病率，犯人组明显高于对照组，特别在疼痛方面。Logistic回归分析进一步说明犯人组对疼痛的感受性明显高于对照组。结论：（1）个性、应激性生活事件和应对方式即心理社会因素是颞下颌关节紊乱病／口颌面痛重要的致病因素和易患因素；（2）诸多颞下颌关节紊乱病／口凳面痛可以被认为是一种心因性疼痛。     

Obesity as a risk factor for temporomandibular disorders

We conducted a clinical cross‐sectional study to evaluate the association between obesity and the presence of painful temporomandibular disorders (TMD), controlling for age, gender, presence of migraine, depression, non‐specific somatic symptoms and obstructive sleep apnoea syndrome (OSAS) in an adult population. A total of 299 individuals (76·6% women) with a mean age of 36·8 ± 12·8 years were evaluated. TMD were classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Depression and non‐specific somatic symptoms were scored by the Symptom Checklist‐90, while pain and disability was rated by the Graded Chronic Pain Scale. Bioimpedanciometry (BIA) was used to assess obesity through total body fat percentage. Migraine was diagnosed according to the criteria of the International Classification of Headache Disorders‐2 (ICHD‐2). OSAS was classified according to the Berlin Questionnaire. We performed univariate and multivariate models, chi‐square tests and odds ratios (OR) with 95% confidence intervals (CI). In the single regression analysis, TMD‐pain was significantly associated with total body fat percentage (P = 0·01). In the multivariate analysis, migraine, age, non‐specific somatic symptoms and OSAS showed to be stronger predictors of TMD‐pain, and obesity did not retain in the regression model. The initial association found between obesity and TMD‐pain is lost when it was corrected for gender, migraine, non‐specific somatic symptoms and OSAS.     

The role of occlusal factors on the occurrence of temporomandibular disorders

Aims:

The aim of this study was to investigate the relationship between occlusal factors and temporomandibular disorders (TMD).

Methodology:

One hundred patients were selected among those who sought medical or dental care in public practice in Recife, Brazil. The presence of malocclusions and absence of five or more posterior teeth were evaluated by the clinical exam. TMD diagnosis was given using Research Diagnostic Criteria (RDC/TMD). Statistics were carried out using Fisher and Mann–Whitney methods with 5% significance level, as well as multiple logistic regression analysis.

Results:

The sample was mainly comprised of women (83%), individuals over 30 years old (57%) and singles (53%). The percentage of TMD and malocclusion in total sample was 42% and 50%, respectively, while in TMD subjects, malocclusion was present in 38·1%. There was no association between TMD and the occlusal factors studied.

Conclusion:

It can be concluded that malocclusion and loss of five or more posterior teeth does not contribute to TMD.