正畸疼痛的研究进展

疼痛是组织损伤或潜在组织损伤所引起的不愉快感觉和情感体验。正畸疼痛会对患者的依从性造成负面影响,也使得许多患者抵制正畸治疗。该文总结了现有的研究中关于正畸疼痛的研究进展,并针对在临床工作中医生和患者可能会产生的疑问寻找可靠的答案。     

正畸治疗中疼痛机制的研究进展

疼痛是正畸治疗中常见的也是令医生最棘手的问题之一。近年来关于正畸治疗中疼痛的机制研究较多,本文综述了该领域的最新进展,归纳并提出了其产生的可能机制。     

正畸疼痛的临床研究

疼痛是正畸牙移动过程中的最常见症状之一。许多研究表明疼痛已经成为患者中断正畸治疗最主要的原因之一,随着患者对治疗舒适度要求的增加,如何监测正畸疼痛,如何减轻正畸治疗过程中的疼痛成为正畸医生的研究热点。本文就正畸过程中产生的疼痛特点以及临床上正畸疼痛的控制方法以及研究进展做一综述。     

正畸治疗中疼痛机制的研究进展

疼痛是正畸治疗中常见的也是令医生最棘手的问题之一,近年来关于正畸治疗中疼痛的机制研究较多,本文综述了该领域的最新进展,归纳并提出了其产生的可能机制。     

正畸疼痛的分析与控制

正畸固定矫治过程中,大多数病人会出现不同程度的疼痛。疼痛是正畸治疗中的常见反应,也是医患双方共同关注的重要问题。因此,本文拟对疼痛概念,发生机理,特点,影响因素及衡量方法,防治措施作一综述。     

音乐缓解正畸治疗性疼痛的临床研究

目的 探讨音乐对正畸治疗性疼痛的缓解作用。方法 根据随机对照原则将初戴固定矫治器的165例患者分为音乐组和空白组,音乐组采用音乐干预正畸性治疗疼痛,空白组不采用任何干预疼痛的措施。应用视觉模拟评分法（VAS）评估受试者的正畸治疗性疼痛强度,并分析受试者的年龄、性别、情绪及人格对音乐缓解正畸疼痛效果的影响。结果 有效调查率为85.45％。音乐组的正畸治疗性疼痛低于空白组（P<0.05）。音乐组和空白组中情绪不稳定患者较情绪稳定患者疼痛明显,内向型人格患者较外向型人格患者疼痛明显（P<0.05）。音乐组中女性患者较男性患者疼痛明显（P<0.05）。结论 音乐对正畸治疗性疼痛的缓解有较好的效果。音乐缓解正畸治疗性疼痛男性优于女性,外向型人格优于内向型人格,情绪稳定者优于不稳定者。     

艾森克人格因素对成人正畸治疗疼痛的影响研究

目的探讨艾森克人格因素对成人正畸患者治疗过程中疼痛的影响,为正畸治疗过程中进行心理治疗以缓解治疗疼痛提供指导依据。方法选择进行正畸治疗的成人患者100例,治疗前由患者填写个人情况,并完成艾森克人格问卷,戴矫治器后采用视觉模拟评分法填写正畸治疗疼痛情况。对结果进行统计分析。结果艾森克人格E量表标准分同正畸疼痛呈负相关(-0.287～-0.358),而P、N、L量表的标准分均与正畸疼痛不相关。E标准分高的组(E≥60)和E标准分低的组(E<60)的正畸疼痛情况之间存在显著差异(P<0.05)。结论外向人格倾向者对疼痛的评分值低于内向人格倾向者。患者的人格倾向会影响患者的疼痛主诉程度,治疗前应对正畸患者进行必要的心理行为干预,以利于患者的健康与合作,提高口腔治疗效果。     

正畸疼痛的临床与基础研究进展

疼痛是正畸治疗过程中的常见症状,不仅影响正畸治疗的最终效果,而且影响患者是否接受正畸治疗的意愿。资料显示,95%的正畸患者出现过不同程度的疼痛症状。如何消除或减轻正畸疼痛,确保正畸矫治效果,改善口腔医疗服务质量,已成为越来越多的正畸医师和患者关注的问题之一。本文总结了正畸治疗中疼痛的表现、特点及可能的机制,并分析比较了目前临床上常用的镇痛措施,旨在进一步明确正畸疼痛的外周神经机制,为临床提供切实可行的疼痛缓解方案。     

正畸治疗时牙周疼痛的临床调查分析

本研究的目的在于探讨正畸病人接受正畸治疗、放置首根弓丝后所发生的正畸疼痛的基本规律，以及性别、年龄与正畸疼痛的关系。通过43例正畸病人初次戴上直丝弓矫治器，放置0．36mmNiTi弓丝后七天内的正畸疼痛程度变化的调查，结果表明：（1）正畸疼痛发生时间从1小时20分钟至13小时30分钟不等，平均发生时间为4小时42分钟。（2）正畸牙周疼痛高峰期处于放置首根弓丝后24～48小时之间，从此以后疼痛逐渐减轻，至第七天，大多数病人已无明显疼痛症状。（3）咀嚼口香糖和上下牙齿紧咬时的正畸疼痛程度两者之间无显著差异（P＞0．05），但它们却明显高于自然状态下的疼痛程度（P＜0.01）。（4）一天内的4个不同时间点，即9点、13点、17点、21点的各疼痛程度无统计学差异。（5）正畸牙周疼痛程度与性别无关。（6）18岁以上组的正畸病人在第1～3天内的正畸疼痛程度与13～17岁及13岁以下组之间无明显差异，但从第4天开始，其疼痛程度和持续时间却明显高于其它两组（P＜0．01或0．05）而后两组之间则无统计学差异（P＞0．05）。提示成年人正畸治疗时正畸疼痛的预防及治疗前的心理准备则显得更为重要。     

儿童固定正畸治疗与疼痛的相关分析

目的：分析固定正畸治疗后患儿的疼痛情况,以期指导正畸的I临床工作和术后护理。方法：随机选取335例进行固定矫治器治疗的儿童患者,采用视觉模拟评分法（VAS）在治疗后2h、6h、夜间、24h、2d、3d及7d分别测量其术后疼痛情况,进行评分及统计分析。结果：正畸治疗2h后疼痛开始加重,其后24h内疼痛程度于夜间达到最高水平,第2d开始疼痛减轻,第7d基本恢复正常状态。咀嚼与否及前后牙的疼痛情况基本相似。结论：VAS法可有效分析儿童接受正畸治疗后的疼痛情况,为医生临床工作和治疗后护理提供有益的指导。     

Traumatic ulcers and pain during orthodontic treatment

In the present investigation the frequency of oral ulcers and pain in 161 orthodontic patients was recorded. Of all patients, 95% had experienced pain, but 84.5% said that the pain lasted a few days only. About 11% maintained that the treatment was constantly painful. Significantly more patients coming from private clinics complained of pain than those attending treatment at the Department of Orthodontics. About 50% said that activating or changing archwire was most annoying, whereas 28.7% said ulceration and 21% said headgear was the most annoying part of the treatment. According to 75% of the patients, sleeping habits were not influenced. Only eight patients reported truancy, and seven of these had done this only once. Of all patients, 6.2% had requested interim visits. Small wounds caused by the fixed appliance were reported by 75.8% of the patients, and 2.5% had suffered badly from ulceration caused by the fixed appliances. More girls than boys reported ulceration. There was a significant sex difference as regards recurrent aphthous ulceration (RAU). Increase in the frequency of RAU was reported by 23.1% of the girls and 9.6% of the boys while they had fixed appliances.     

Traumatic ulcers and pain in adults during orthodontic treatment

In the present investigation the frequency of oral ulcers and pain in 79 adults orthodontic patients was recorded. Only four of all patients had never had oral ulceration during treatment, but 83% of the patients characterized the trouble as minor. About 47% of the patients said that ulcers caused by the fixed appliance were the most annoying part of the treatment, and 38% said that activation of the appliance caused the most discomfort. In about 63% of the patients there was less pain when the treatment had lasted for some months, and in 24% there was no significant change in the discomfort. The pain following activation lasted for only 2-3 days (71%), but 20% had pain for more than 3 days, and five individuals felt pain constantly. The recurrence of aphthous ulceration (RAU) was not significantly affected during the orthodontic treatment, and in only one case was there an increase in the occurrence of herpes labialis.     

耳穴压豆法减轻正畸治疗疼痛的临床效果观察

目的:观察耳穴压豆法减轻正畸治疗牙周疼痛的临床效果.方法:选择初次正畸治疗患者40人,初次戴入矫治弓丝后随机分为实验组和对照组,每组20人.实验组上弓丝后即加用耳穴磁疗法;对照组复诊时用耳穴磁疗法,观察记录患者牙周疼痛的发生率、疼痛的持续时间,并对其进行统计学分析.结果:应用耳穴压豆法的正畸患者疼痛发生率明显降低,持续时间也明显减少(P＜0.05).结论:耳穴压豆法能有效减轻正畸治疗时的牙周疼痛.     

A longitudinal evaluation of pulpal pain during orthodontic tooth movement

Objectives – To examine the longitudinal changes in pulpal sensitivity to electrical stimulation and the relationship to pulpal sensitivity as measured by electrical stimulation and subjective reports of tooth pain after archwire insertion. Design – Non‐randomized, prospective trial, with matched controls. Setting and Sample Population – Regional Clinical Dental Research Center at the University of Washington School of Dentistry. Eighteen adult subjects of age 13–37 years. Nine experimental subjects planned for orthodontic treatment. Nine control subjects matched for gender and age who did not have orthodontic treatment. Experimental Variable – Fixed orthodontic appliances and initial archwire placement in experimental subjects compared with `no treatment' control subjects. Outcome Measure – Subjective assessments of orthodontic tooth pain were made using visual analogue scales. Electrically evoked detection and pain thresholds were determined using a computer‐controlled tooth stimulator. Data were gathered at five time points: after bracket placement (baseline), 1 h after placement of initial archwires, 1 day after archwire placement, 1 week after archwire placement, and 1 month after archwire placement. Comparable time intervals were used for the `no treatment' control subjects. Results – Subjective ratings of treatment‐evoked tooth pain in the experimental group were the greatest at the post‐archwire day 1 observation and progressively decreased for the remaining observations. Control subjects reported little pain at any of these observation times. The detection and pain threshold changes from baseline showed no statistical differences over time or between groups. While not statistically significant, a trend was noted where reports of greater orthodontic tooth pain were associated with increased sensitivity to electrical stimulation (i.e. lower detection and pain thresholds). Conclusion – Orthodontic patients experience significant pain and discomfort 1 day after initial archwire placement (i.e. activation). Future research should investigate whether self‐reports of treatment‐evoked tooth pain intensity are associated with pulpal sensitivity.     

正畸治疗中牙根吸收的影响因素

牙根吸收是正畸治疗中的常见并发症，其直接影响治疗效果及牙齿的健康。正畸治疗诱导的牙根吸收是无法完全避免的，它的影响因素也非常复杂。控制牙根吸收，首先要了解其病因，本文将对牙根吸收的影响因素作一综述。     

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颞下颌关节紊乱病（TMD）是一种由关节结构、咬合、肌功能异常及精神心理等多种因素综合作用形成的口颌面部疾病。闭锁型深覆[牙合]、个别前牙与后牙反[牙合]、后牙锁[牙合]、一侧后牙反[牙合]、下颌偏斜、磨牙伸长、磨牙倾斜等是诱发TMD的高危险[牙合]因素。从整体分析,正畸治疗与TMD并无密切相关性,但部分病例TMD的发生仍可能与正畸治疗不当有关。良好的牙齿排列、正常的前牙覆[牙合]与覆盖关系及后牙尖窝对应关系、牙位与肌位一致、下颌前伸与侧[牙合]平衡是有效预防与缓解TMD的可靠保证。本文对错[牙合]畸形及正畸治疗与TMD的相关性研究文章进行系统回顾,结合正畸临床实际,分析错[牙合]畸形与TMD的内在联系,以及正畸治疗中TMD的风险和防治策略。     

青少年正畸患者在治疗中合作行为的研究

目的了解青少年正畸患者在治疗过程中的心理及行为表现,为建立合作评定量表形成理论建构(即量表组成的框架或结构).方法在全国范围内选取184名正规专科正畸医师为对象进行问卷调查及临床晤谈,收集正畸患者在治疗中与合作情况有关的表现,最后对不合作的典型行为排序,将不同地域的三组(北京、上海、其它)各20例的排序结果进行地区差异比较.结果青少年患者合作行为表现不但体现在如何对待矫治装置、口腔卫生、时间观念等,还包括心理状态、个性特征及家庭和社会环境等多方面,归结为自律性、主动性、自觉性以及人际关系等,同时又具有青少年时期的特殊性.不同地域的不合作行为基本相似.结论1、合作行为量表的理论建构应为四方面内容自律性、主动性、自觉性和人际关系等.2、在此基础上建立的青少年正畸患者合作行为量表在全国范围应用是实际可行的.