老年人颞下颌关节紊乱病的(牙合)重建治疗

目的:观察(牙合)重建治疗老年人颞下颌关节紊乱病的临床疗效.方法:采用暂时性咬合板治疗26例因后牙缺失或重度磨耗所导致的老年TMD患者,3个月后待症状缓解时以金属烤瓷冠桥或可摘局部义齿对其进行永久性(牙合)重建治疗,随访时间(牙合)重建后3个月至3年.结果:戴暂时性咬合板3个月时,患者疼痛、弹响、张口受限症状消失分别为80.7%、56.5%和70.6%;永久性(牙合)重建后随访以上各项指标为88.4%、69.6%和82.3%.结论:(牙合)重建治疗对于老年人因后牙缺失及重度磨耗所致的TMD是一种有效的保守治疗方法.     

应用T-Scan II系统对TMD患者调治疗的分析研究

目的 :探讨对TMD患者进行调牙合治疗的意义。方法 :应用先进的T ScanII咬合接触测定分析系统 ,在患有TMD的患者调牙合前后分别进行咬合接触检测 ,结合疼痛症状分析表来进行综合评价。结果 :调牙合治疗后咬合接触点明显增加 ,且双侧趋于平衡接触 ,VAS指数明显降低 ,由原来 5 .3降为 1.9,临床症状得到明显改善。结论 :调牙合治疗对TMD具有积极的治疗作用     

颞下颌关节紊乱病在不同年龄群体的调查研究

目的:探讨不同年龄群体的颞下颌关节紊乱病(TMD)的患病情况,临床特点及其差异性。方法:采用随机整群抽样方法,抽取368名65～75岁广东籍老人和681名18～23岁广东籍大学生作为研究对象。应用非条件Logistic回归模型和χ2检验对调查结果进行分析。结果:在老人组,TMD体征阳性者239名(239/368,64.9%),表现为关节弹响和杂音46人次(46/368,12.5%),下颌运动异常58人次(58/368,15.8%),疼痛192人次(192/368,52.2%),人均临床症状1.2(296/239);在大学生组中,TMD体征阳性者286名(286/681,41.9%),表现为关节弹响和杂音102名(102/681,15%),下颌运动异常185名(185/681,27.2%),疼痛127名(127/681,18.5%),人均临床症状1.4(414/286)。老年人后牙缺失、偏侧咀嚼和牙合创伤是主要危险因素;而在大学生组,精神因素、错颌畸形/下颌第三磨牙阻生、偏侧咀嚼是这一年龄段人群TMD发生的主要危险因素。结论:广东籍老年人TMD的发病率高于大学生组,后牙缺失是老年人TMD发生的最主要致病因素;精神因素则是大学生群体TMD发病的首要致病因素。老年人首要临床症状是疼痛,而大学生则是弹响与杂音。     

老年人不良义齿修复致颞颌关节紊乱24例报告

目的对老年人全口义齿不良修复引起的颞颌关节紊乱病(TMD)的原因、诊断、治疗进行研究.方法对24例老年人全口义齿不良修复出现面肌疼痛、关节弹响、张口困难等进行对比分析.结果旧义齿组与新义齿组摄X光片检查,对关节前、中、后间隙进行测量比较有明显统计学意义(p<0.05).结论 TMD形成是一个多因素的结果,治疗时应该着全面考虑.     

Roth诊断垫治疗颞下颌关节紊乱病的初步探讨

目的:观察使用Roth诊断垫治疗颞下颌关节紊乱病(Temporom-andibular disorder,TMD)的疗效。方法:选取76名TMD患者,随机分成2组。治疗组患者24h佩戴Roth诊断垫;对照组患者仅给予TMD健康指导。观察6个月后,应用Fricton颞下颌关节紊乱指数评价TMD患者临床症状。将治疗组和对照组治疗前后差异进行统计学分析。结果:治疗组与对照组治疗前后Fricton指数减少有显著性差异。结论:使用Roth诊断垫治疗某些颞下颌关节紊乱病有明显效果。     

关节冲洗术治疗颞下颌关节紊乱病的临床研究

目的　观察和评价关节冲洗术治疗颞下颌关节紊乱病 (TMD)的临床效果。方法　对 86例出现急性疼痛、开口受限的TMD患者采用关节冲洗疗法进行治疗 ,比较治疗前后患者张口度和疼痛程度的变化 ,并对两种冲洗方法的效果进行了比较。结果　关节冲洗对恢复张口度和缓解疼痛有显著的疗效 ,两种冲洗方法的疗效无显著差异。结论　关节冲洗对出现关节绞锁症状的TMD患者是一种简便、微创、有效的治疗方法。     

关节上下腔留注透明质酸钠治疗TMD疗效观察

目的　探讨关节上下腔注射透明质酸钠 (HA)治疗TMD的方法及疗效。方法　对 37例TMD患者行HA上下腔注射为试验组 ,另 33例TMD患者行HA上腔注射为对照组 ,并从开口度、开口型、疼痛指标作定性、定量分析。结果　对照组治疗TMD疗效较好 ,试验组治疗TMD效果显著 ,两者有显著差异 (P <0 .0 5 )。结论　关节上下腔注射HA治疗TMD是一种更有效的非手术治疗方法     

TMD患者咬合板治疗后接触变化的研究

目的:比较咬合板治疗颞下颌关节紊乱病(TMD)前后异常因素的变化情况,探讨咬合板治疗TMD的机理。方法:选取34名用咬合板治疗的TMD患者,记录其戴用咬合板后2个月时的咬合特征及临床症状,并与治疗前进行比较。结果:TMD患者治疗后的力中心距中线距离减小,闭合时间与侧方分离时间明显较治疗前缩短,早接触出现率较治疗前降低,但前伸分离时间、非工作侧干扰及前伸干扰的出现率与治疗前相比无显著性差异。结论:咬合板对于纠正力中心位置、减小早接触的发生率、缩短闭合时间及侧方分离时间具有明显的作用,能够使TMD患者的关系向着更加协调、稳定的方向发展,是其有效治疗TMD的重要机理。     

拔除阻生智牙治疗大学生颞下颌关节紊乱病临床效果研究

目的 探讨拔除阻生智牙治疗大学生颞下颌关节紊乱病（temporomandibular disorders,TMD）的临床效果。方法 选择2009年9月以来广东工业大学医院口腔科青年大学生TMD并智牙阻生患者136例,随机分为2组,每组68例,试验组采取心理+药物+局部理疗+阻生牙拔除术等综合治疗,对照组仅采取心理+药物+局部理疗等保守治疗。两组完成治疗后随访观察1年,对比疗效差异。结果 试验组总有效率为91.2%,对照组总有效率78.0%,两组疗效差异有统计学意义（P＜0.05）。结论 拔除阻生智牙对治疗青年大学生TMD有较好的疗效,可列为青年大学生TMD系列治疗方法之一。     

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目的探讨拔除阻生智牙治疗大学生颞下颌关节紊乱病（temporomandibular disorders,TMD）的临床效果。方法选择2009年9月以来广东工业大学医院口腔科青年大学生TMD并智牙阻生患者136例,随机分为2组,每组68例,试验组采取心理＋药物＋局部理疗＋阻生牙拔除术等综合治疗,对照组仅采取心理＋药物＋局部理疗等保守治疗。两组完成治疗后随访观察1年,对比疗效差异。结果试验组总有效率为91.2%,对照组总有效率78.0%,两组疗效差异有统计学意义（P〈0.05）。结论拔除阻生智牙对治疗青年大学生TMD有较好的疗效,可列为青年大学生TMD系列治疗方法之一。     

Longitudinal Changes in Temporomandibular Disorders in Young Adults: Indication for Systematic Temporomandibular Joint Screening

OBJECTIVE: The aim of this study was to investigate longitudinal changes in temporomandibular joint function in young adults in terms of clinical and subclinical temporomandibular disorders (TMD), and to identify patients at risk for clinically manifest TMD. SUBJECTS AND METHODS: Ninety-one consecutive dental students were surveyed over a mean period of 2.4 years. The temporomandibular joint and masticatory muscles were analyzed by means of the Manual Functional Analysis. Examinations took place during the first (T1) and sixth (T2) terms of dental training. RESULTS: The prevalence of subclinical TMD decreased from 16.5% to 15.4%, while that of clinical TMD rose from 19.8% (T1) to 24.2% (T2). Subjects with subclinical TMD at T1 showed the most pronounced fluctuation, and were about equally likely to improve, remain stable or deteriorate. The incidence of clinical TMD in the subclinical TMD-group was 28.6%, that is, almost every third subject developed clinical TMD over a 2.4-year period. CONCLUSIONS: Should clinical TMD become apparent during orthodontic treatment, the patient might attribute it to the therapy, rather than to the subclinical disorder at baseline. It thus makes therapeutic and forensic sense to carry out systematic TMJ-screening in all adult patients prior to orthodontic treatment, in order to identify patients at risk.     

颞颌关节紊乱病患者心理学相关因素分析

目的对40例非咬合因素引起的颞颌关节紊乱病(TMD)患者进行心理学研究,了解TMD与心理障碍的关系。方法对40例TMD患者进行心理学病因、心因性躯体化症状观察,并对与TMD患者相配对的正常组进行自评焦虑量表(SAS)、自评抑郁量表(SDS)、症状自评量表(SCL90)量表分析。结果40例TMD患者主要的心理学病因有恐癌症、疑病症,工作紧张,生活事件,家庭矛盾。所有患者均存在心因性躯体化症状,最常见为睡眠障碍;存在中、重度的焦虑(75％)和抑郁(90％);SCL90量表主要是焦虑、抑郁、敌对和躯体化(P<0.01)。结论 非咬合因素引起的TMD患者存在着不同程度的心理障碍,心理学病史、躯体化症状具有临床参考价值;心理量表分析可进一步明确心理障碍的类型和程度,心理行为治疗对这类TMD有一定的帮助。     

老年牙体重度磨耗伴牙列缺损关系处理的临床研究

目的探讨老年牙体重度磨耗伴牙列缺损关系处理问题。方法对86例老年牙体重度磨耗伴牙列缺损关系分为三类处理：①垂直距离不改变;②一次升高垂直距离修复;③一次升高垂直距离过渡修复,采用了多种修复方式。随访时间为3个月～5年,其中72例两年以上。结果患者的咀嚼功能均得到了明显改善;美观方面获得了不同程度的满意度;修复后多数未出现颞下颌关节问题（TMD）,偶发者经调后消失,修复前有TMD者,经修复治疗得到了缓解或并未加重;牙体牙髓牙周及修复体等一般情况多数良好。结论按本研究分类处理老年牙体重度磨耗伴牙列缺损关系的方法,临床易于掌握,既可保证患者疗效又适当缩短了疗程,取得了良好的临床效果。     

Manual physical therapy interventions and exercise for patients with temporomandibular disorders

The purpose of this study was to investigate the outcome of a series of consecutive patients with temporomandibular disorder (TMD) who were treated with manual physical therapy interventions and exercise. Consecutive patients with the clinical presentation of TMD completed several self-report measures and underwent a standardized historical and physical examination. Following the examination, patients received a multimodal treatment approach incorporating manual physical therapy and exercise. All self-report questionnaires were completed at a 2-week follow-up. Paired t-tests were performed between the baseline and 2-week follow-up scores. The mean TMD Disability Index scores were 32.1% (15.4%) at baseline and 18.3% (12.5%) at the 2-week follow-up, representing an improvement of 13.9% (CI: 8.2%, 19.5%) (p < 0.05). Patient Specific Functional Scale (PSFS) scores improved 3.1 points (CI: 2.3, 3.9) (p < 0.05). These results suggest that patients with TMD who are treated with a rehabilitation program including manual physical therapy interventions plus exercise, with or without iontophoresis with dexamethasone, can demonstrate clinically meaningful improvements in disability and overall perceived change in a relatively short period of time.     

Treatment received, treatment demand and treatment need for temporomandibular disorders in 35-year-old subjects

Especially in the last 10 years the aetiological significance of occlusion for TMD was relativated and the search for other alternative therapeutic strategies was intensified. For the treatment of myogenous and arthrogenous problems in TMD different kinds of physiotherapy are reported. Our intention of the present pilot study was focused on patients' perception of efficiency of different physiotherapeutic modalities and in relation to splint therapy.
A total of 187 patients of the TMD clinic in Düsseldorf were retrospectively asked to fill out a questionnaire with topics on physiotherapeutic home training programme (HTP), on professional physiotherapy (PP), on splint therapy (ST) and overall assessment of treatment effort (OATE). Eighty-one questionnaires could be analysed and evaluated in relation to three diagnostic TMD subgroups (myogenous, arthrogenous and mixed).
The HTP was positively assessed in 74%, PP in 70% and ST only in 38%. Fifty-one per cent of patients could realize HTP regularly per day, 86% of patients could realise PP regularly per week. The majority of patients felt improvement after some weeks/months of HTP resp. PP. No significant relation could be detected between TMD subgroups and patients'assessment to HTP, PP, ST and OATE.
Based on patients' assessment the results indicate that physiotherapeutic treatment modalities are highly efficient, whereas a differentiation between mentioned TMD subgroups does not seem to exist. A minority of patients (c. 20–25% of clinical cases) does not respond to dental-occlusal and physiotherapeutic therapy very well. Therefore, a multidisciplinary psychosocial-based treatment approach might be useful in these cases.     

A 5-year follow-up of signs and symptoms of TMD and radiographic findings in the elderly

PURPOSE: The aim was to clarify the associations among subjective symptoms, clinical signs of temporomandibular disorders (TMD), and radiographic findings in the mandibular condyles of elderly people during a 5-year follow-up. MATERIALS AND METHODS: As part of a comprehensive medical survey of a random sample born in 1904, 1909, and 1914 (Helsinki Aging Study), 364 subjects living in Helsinki participated in the dental part of the examination during 1990 and 1991; after 5 years, 103 of these were reexamined. Comprehensive data on TMD were available for 94 subjects, and radiographic data were available for 88. TMD were assessed by Helkimo's anamnestic and clinical indices, and radiographic status was assessed by panoramic radiographs. RESULTS: During the 5-year follow-up, reported anamnestic symptoms of TMD for men changed little (9%); among women, the change from baseline was 42%. When the unchanged indices were compared, the gender difference was obvious. At baseline, 5% of the women, but no men, had severe signs (clinical index III) of TMD. At the end of follow-up, none showed severe signs. Comparison of radiographic findings between baseline and follow-up showed no differences, nor did differences appear in associations between radiographic findings and anamnestic or clinical indices. CONCLUSION: During the 5-year follow-up, signs and symptoms of TMD in these elderly individuals became milder or vanished. The radiographic status of the condyles remained stable, and no association appeared between radiographic findings and signs and symptoms of TMD.     

TMD调[牙合]治疗10例临床分析

目的：观察调[牙合]治疗颞下颌关节紊乱病（TMD）的临床效果。方法：10例TMD患者,在T-scanⅡ咬合力计的指导下进行调耠,根据治疗前、治疗后3个月的临床症状及面部疼痛指数（VAS值）变化情况进行临床疗效分析。结果：调[牙合]治疗后,10例TMD患者的临床症状均得到了不同程度的改善。颌面部疼痛指数（VAS值）变化有显著性差异中〈0．05）。结论：T-scanⅡ咬合力计指导下的调[牙合]治疗可以实现精准调[牙合],是治疗TMD的有效方法。     

Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis

Summary The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94·4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20·0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11·1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.