颞下颌关节紊乱病疼痛的分子机制

颞下颌关节紊乱病是一种多因素疾病,在临床上以疼痛为主要症状。关于颞下颌关节紊乱病的疼痛机制迄今仍未完全明了,因而其治疗也没有取得突破性进展。近年来,颞下颌关节紊乱病疼痛的分子机制已成为国内外研究的热点,本文就此作一综述。     

激光治疗在颞下颌关节紊乱病中的应用

颞下颌关节紊乱病（ TMD）是口腔临床常见疾病之一,病因多样,治疗方法也多种多样。近年来,激光治疗在TMD中的应用受到人们的关注。本文就激光在TMD治疗中的疗效、疗效评价、作用机制及相关影响因素进行综述。     

颞下颌关节紊乱病诊断标准的研究进展

颞下颌关节紊乱病(temporomandibular disorders,TMDs)是临床常见病但是病因复杂,相应的颞下颌关节紊乱病的诊断标准也在不停演变.本文围绕由RDC/TMD到DC/TMD的改进,DC/TMD的临床应用实施进行综述,并对未来可能的发展进行展望.     

消炎痛贴片治疗颞下颌关节紊乱病疼痛的临床研究

目的：评价消炎痛贴片透皮吸收靶向给药治疗颞下颌关节紊乱病（Temporomandibular disorders,TMD)疼痛的临床疗效。方法：100例关节疼痛、开口受限TMD患者，随意分三组：试验组，中药组，对照组。患侧局部贴敷给药，连续治疗7天，观察治疗前后各组患者的疼痛值（用VAS法测定）、开口度的变化。结果：治疗后第3天，第7天观察实验组疼痛有显著缓解，试验组治疗总有效率为86．7％，明显优于中药组和对照组。结论：消炎痛透皮吸收贴片治疗TMD患者，能缓解疼痛，增加开口度，该方法安全、有效，有临床推广的价值。     

半导体激光治疗颞下颌关节紊乱病的疗效探讨

颞下颌关节紊乱病为颞下颌关节疾病中最常见的一种[1],由于其特定的生理解剖与频繁的活动,使其极易产生一系列结构与功能紊乱。临床表现为疼痛、张口异常,关节弹响等,但其病因与发病机制较复杂,故临床治疗方法较多,疗效不一。以往常用的方法为理疗和药物治疗,自2000年始,我科采用半导体激光[2]治疗该病,取得了较为满意的疗效,现总结报告如下。1病例与方法1.1临床资料2000年～2002年,我科门诊治疗颞下颌关节紊乱病患者176例。其中激光治疗组128例,男58例,女70例,年龄23～80岁;红外线治疗组48例,男22例,女26例,年龄25～74岁。患者主诉颞下颌关…     

颞下颌关节紊乱病的治疗

关于因素是否颢下颌关节紊乱病(TMD)病因之一,以及TMD的治疗,现存在着各种争议.本文回顾了有关研究及观点.目前,无论是动物实验研究,还是临床实验研究,都不足以作出因素是TMD病因之一的结论.但是, 治疗在TMD临床治疗中占有重要地位,且发挥重要作用:调能有效地缓解慢性头痛,颈痛及肩部痛; 治疗对减轻TMD患者的肌肉疼痛也显示理想效果;调位咬合板能消除一部分关节弹响.进一步探索TMD的因素,正确掌握TMD 治疗的适应证及客观科学地评价治疗的临床效果是我们今后研究的课题.     

颞下颌关节紊乱病患者疼痛的临床描述分析

目的通过研究颞下颌关节紊乱病（TMD）患者对疼痛的主观描述情况,分析TMD患者疼痛的特点。方法选择以口颌面部疼痛为主诉的TMD患者90例为研究对象,检测患者疼痛的强度和相关功能丧失的程度,记录患者自述的疼痛规律和描述疼痛的词汇。结果90例患者主要为轻到中等强度的疼痛,男女之间以及急、慢性期之间疼痛强度的差异无统计学意义（P>0.05）。TMD疼痛对咀嚼功能的影响最大,其次是对心情状况有比较大的影响。急、慢性期患者下颌静止时疼痛出现率无统计学差异（P>0.05）。急性期患者常用酸痛、隐痛、刺痛和抽着痛来描述疼痛,慢性期患者常用的词汇是钝痛、木痛和胀痛。结论急、慢性期TMD导致的疼痛强度均较低,主要影响患者的咀嚼功能和心理状态。急、慢性TMD疼痛的描述词汇有所不同。     

精神因素致颞下颌关节紊乱病1例

患者，女，35岁，因张口受限伴右侧颞下颌关节区疼痛2天就诊。患者自述近日因家庭原因导致精神状态较差，夜间睡眠不好，晨起时常感双侧面颊部疲劳，5天前开始感觉下颌运动时右侧颞下颌关节区轻微疼痛，并未治疗；近2天疼痛加重并向右颞部及头顶放射，且张口受限。否认颞颌关节病史及夜磨牙史。临床检查：患者面部左右基本对称，右侧     

低强度激光治疗颞下颌关节紊乱病的疗效评价

目的 评估低强度激光(LLLT)疗颞下颌关节痛的效果.方法 将颞下颌关节痛的患者按随机、双盲原则分为激光组(n=21)和对照组(n=21),每位患者均接受连续6d、每天1次的激光或假激光治疗.在治疗前、治疗后、治疗后1月、治疗后2月14个时点对患者的疼痛程度、功能状态进行测量和评估.结果 2组中疼痛视觉模拟评分(VAS...     

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颞下颌关节紊乱病(TMD)的保守治疗方法很多,本文重点介绍了目前临床上常用的有关TMD保守治疗的咬合板的类型、作用和适应证。咬合板治疗是临床治疗TMD的首选疗法,但目前缺乏设计完善的临床试验以证实其疗效。建议推行临床试验透明化,实施临床试验注册制度和高质量的随机对照试验(RCT),以便于总结咬合板治疗TMD的临床证据,提高TMD临床治疗水平。     

Effects of exercise therapy on painful temporomandibular disorders

Temporomandibular disorders (TMD) are common chronic musculoskeletal pain conditions among orofacial pain. Painful TMD condition such as myalgia and arthralgia can be managed by exercise therapy. However, as it is hard to access actual effect of each modality that is included in an exercise therapy programme due to multiple choice of the management modality, their efficacy remains controversial. Therefore, this review focused on the effects of exercise therapy for the management of painful TMD. The aims of this review were to summarise the effects of exercise therapy for major symptoms of painful TMD and to establish a guideline for the management of painful TMD, resulting in higher quality and reliability of dental treatment. In this review, exercise modalities are clearly defined as follows: mobilisation exercise, muscle strengthening exercise (resistance training), coordination exercise and postural exercise. Furthermore, pain intensity and range of movements were focused as outcome parameters in this review. Mobilisation exercise including manual therapy, passive jaw mobilisation with oral appliances and voluntary jaw exercise appeared to be a promising option for painful TMD conditions such as myalgia and arthralgia. This review addressed not only the effects of exercise therapy on various clinical conditions of painful TMD shown in the past, but also an urgent need for consensus among dentists and clinicians in terms of the management of each condition, as well as terminology.     

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提要：颞下颌关节紊乱病（TMD）是口腔临床常见病之一,其治疗方法众多。咬合板作为一种保守、可逆的治疗方法被广泛应用在TMD的治疗上。然而,各类咬合板治疗TMD的疗效尚不完全明确,本文结合近年来国内外文献对其进行综述。     

The gap between dental education and clinical treatment in temporomandibular disorders and orofacial pain

Implementation of research findings in patient care ideally will follow in a continuous cycle, and clinical questions from practitioners should stimulate research. Even in the most optimal situations, there will be a gap between the steady flow of new findings from research and their eventual implementation in clinical practice. In the clinical practice of temporomandibular disorders and orofacial pain (TMD/OFP) simple cases outnumber the more complex cases by far. Therefore, research implications for the general dental practitioner, whose patients are rarely represented in research populations, may differ from what is published and taught. Treatment options like counselling, occlusal treatments (reversible as a rule and irreversible by exception) and physiotherapy can be very successful in the hands of the general dental practitioner. European dental schools should define additional amendments to the recently proposed profile and competencies for the European dentist, in order to focus on the relevant and current knowledge on temporomandibular disorders and orofacial pain. These amendments should address the adequate diagnosis and management of non-complex TMD cases and the need to refer to a TMD/OFP specialist in complex cases. Professional organizations such as the European Academy of Craniomandibular disorders can endorse better TMD/OFP education and training.     

Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review

Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected.

Objective

To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD.

Material and Methods

The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events.

Results

After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm², while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo.

Conclusion

Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.     

Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders

There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus‐based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long‐term aim was to establish a foundation, vis‐à‐vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.     

The relationship between neck pain and cervical alignment in patients with temporomandibular disorders

ABSTRACT

Objective: To elucidate the impact of neck pain on cervical alignment in patients with TMDs.

Method: Patients diagnosed with TMDs between November 2013 and November 2015 were included. All subjects underwent lateral cervical X-ray evaluation and completed the RDC/TMD Axis II Biobehavioral Questionnaire for TMDs. Patients with neck pain also completed the Neck Pain & Disability Scale (NPDS). Cervical lordosis angle was measured according to C2-C7 Cobb’s method.

Results: The mean cervical lordosis angle of the whole group (n = 60) revealed hypolordosis (10.9 ± 12.7°). Cervical lordosis angle did not differ between patients with (n = 28) and without (n = 32) neck pain (12.2 ± 12.8° versus 9.8 ± 12.7°, respectively; p = 0.46). TMD-related variables were not correlated with cervical alignment but were moderately correlated with NPDS score, with the exception of TMD-associated disability.

Conclusion: Patients with TMDs have hypolordotic cervical malalignment (tendency toward kyphosis) regardless of neck pain.     

咬合板对颞下颌关节紊乱病相关颌面部疼痛的影响

颞下颌关节紊乱病（temporomandibular disorders, TMD）是口颌面部慢性痛的主要来源,严重干扰日常活动。咬合板是颞下颌关节紊乱病的最常用的治疗方法之一,但其疗效尚未完全明了。学者们多年来致力于对咬合板的作用机制、疗效的研究,但至今尚未得出统一的结果。该文将对咬合板的作用机制、咬合板的分类、TMD相关疼痛的种类与咬合板的选择、TMD的其他保守治疗与咬合板的关系四个方面对于咬合板治疗颞下颌关节紊乱病相关颌面部疼痛的疗效进行进行综述。     

Psychosocial factors associated with pain outcomes in patients with painful temporomandibular disorders and headaches

The objective of this study was to assess the association between psychosocial factors (in terms of anxiety, somatization, depression, and optimism) and pain (in terms of headache pain intensity and pain-related disability), in patients with a painful temporomandibular disorder (TMD) and one of the following headache types: migraine, tension-type headache (TTH), or headache attributed to TMD, corrected for the influence of bruxism. A retrospective study was conducted at an orofacial pain and dysfunction (OPD) clinic. Inclusion criteria were painful TMD, with migraine, TTH, and/or headache attributed to TMD. Linear regressions were performed to assess the influence of psychosocial variables on pain intensity and on pain-related disability, stratified per headache type. The regression models were corrected for bruxism and the presence of multiple headache types. A total of 323 patients (61% female; mean age 42.9, SD 14.4 years) were included. Headache pain intensity only had significant associations in TMD-pain patients with headache attributed to TMD, and anxiety showed the strongest relation (β = 0.353) with pain intensity. Pain-related disability was most strongly associated with depression in TMD-pain patients with TTH (β = 0.444), and with somatization in patients with headache attributed to TMD (β = 0.399). In conclusion, the influence of psychosocial factors on headache pain intensity and pain-related disability depends on the headache type presenting.