颞下颌关节紊乱病患者牙弓宽度的测量分析

流行病学调查发现几乎60%的人至少有一项颞下颌关节紊乱病(TMD)的症状或体征,且因素在其病因和病理中占有很重要的地位。上、下牙列宽度不调是一种重要的异常表现,本研究比较正常人及TMD患者的牙弓宽度,探讨TMD发病与牙弓宽度间的相关性。1材料与方法1.1临床资料2004-05~09间以TMD症状为主诉前来我院就诊的连续的病例,入选条件:上下牙列整齐,上下左右四个牙列区每区缺牙不多于2个,共73例,年龄范围16~69岁,平均年龄37.3岁。对照组来自我校1998年级入学的本科生(17~19岁),入选条件:没有明显的TMD症状、体征,上下牙列整齐,共228名。1…     

颞下颌关节紊乱病症状、体征与心理焦虑状态的相关性分析

目的:分析颞下颌关节紊乱病(temporomandibular disorders,TMD)患者症状、体征及相关因素与心理焦虑状态的相互关系.方法:检查250名患有颞下颌关节紊乱病患者的相关症状及体征.采用一般情况调查问卷及心理焦虑状况量表(SAS)调查患者一般情况及心理焦虑状况.分析TMD患者的症状、体征及相关因素与患者心理焦虑状况的相互关系.结果:TMD患者焦虑分值(44.19±11.01)高于我国焦虑常模的标准分(29.78±10.07)(P＜0.01),不同症状TMD患者心理焦虑状况具有差异(P＜0.01).疼痛及开口受限患者心理焦虑程度高于单纯关节弹响患者,不同程度TMD症状患者心理焦虑状况具有差异(P＜0.01).结论:TMD患者的心理焦虑状况与TMD的临床症状、体征关系密切.     

DC/TMD推荐心理量表在颞下颌关节紊乱病诊疗中的应用

目的: 采用新版DC/TMD推荐的心理量表,评估颞下颌关节紊乱病（temporomandibular disorders, TMD）患者焦虑、抑郁及躯体症状等心理状况,探讨新版量表作为TMD心理轴诊断依据的临床意义。方法: 选择100例TMD初诊患者作为实验组,100例无TMD症状的普通门诊患者作为对照组。收集2组患者的一般信息,包括年龄、性别、受教育程度、个人收入等。采用广泛性焦虑症量表（GAD-7）、抑郁症状量表（PHQ-9）和健康问卷量表15（PHQ-15）对患者心理因素进行评估。采用SPSS 20.0软件包对数据进行统计学分析。结果: <30岁组和30~50岁组TMD发病率显著高于50岁以上年龄组（P<0.05）。实验组高学历者比例显著高于对照组（P<0.05）,而收入水平不是罹患TMD的危险因素（P=0.642）。实验组焦虑发生率与平均得分显著高于对照组（P<0.05）,而两组间抑郁和躯体症状得分无统计学差异（P>0.05）。疼痛性TMD患者的焦虑和抑郁程度显著高于关节疾病患者（P<0.05）,而两组间躯体症状无显著差异（P>0.05）。结论: 性别（女）、年龄（<50岁）和高学历（本科及以上）是罹患TMD的高危因素,而与收入水平无关。TMD患者的焦虑发生率和评分均高于普通口腔门诊患者,但抑郁和躯体症状与普通患者的发生率无显著差异。     

颞下颌关节紊乱病相关疼痛与年龄、性别及骨关节病影像学改变的关系

目的探讨颞下颌关节紊乱病（TMD）患者相关疼痛和年龄、性别及骨关节病（OA）影像学改变的关系。方法1206例TMD患者根据年龄、性别、是否疼痛及影像学改变分组；计算颅下颌关节紊乱指数（CMI）并进行统计学分析。结果TMD相关疼痛女性多见，45岁以下各年龄组间CMI差异有统计学意义，女性OA影像学改变发生率高于男性（P〈0．001）。结论TMD相关疼痛和OA影像学改变易发生于女性，临床病例中16～30岁女性患者最多，并存在TMD相关疼痛和OA影像学改变。     

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。     

错(牙合)少年儿童口腔不良习惯与颞下颌关节紊乱病的相关性研究

目的探讨少年儿童口腔不良习惯、错(牙合)与颞下颌关节紊乱病(TMD)之间的关系.方法本文以106例TMD错(牙合)少年儿童为对象,以问卷调查、关节检查及薛氏位片等手段对患者的口腔不良习惯、主观症状等进行调查,同时对客观体征、(牙合)及咬合以及髁状突位置等进行检查.结果15～17岁TMD患者比例最大;约57.6%的TMD患者有不同程度的不良习惯,以唇习惯最多;TMD错(牙合)青少年不良习惯发生率较高,差异有显著性(P<0.005).结论青少年儿童口腔不良习惯、错(牙合)与TMD之间相互影响;不良习惯在错(牙合)畸形形成和TMD发生有着重要影响.     

单侧有多种症状的颞下颌关节紊乱患者双侧关节锥形束CT对比研究

目的:探讨单侧有多种症状的颞下颌关节紊乱(temporomandibular disorders,TMD)患者双侧颞下颌关节(temporomandibular joint,TMJ)在锥形束CT(cone-beam computed tomography,CBCT)成像上可能存在差异的参考层面,为TMD诊断和对比研究提供参考.方法:选取仅一侧TMJ有多种症状的TMD患者(不含仅有一种症状的病例)50例,通过CBCT三维成像和重建,观察比较同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS 13.0软件包对每例患者上述各测量指标进行两配对样本t检验.结果:两侧TMJ在矢状位60°关节间隙时的测量值差异显著(P＜0.05),平行位120°关节间隙、矢状位90°关节间隙时的测量值差异显著(P＜0.01),其余测量值均无显著差异.结论:对于单侧有多种症状的TMD患者,矢状位或垂直位是较易观察到两侧关节有差异的位置,在这一层面重建意义较大.     

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.     

错(牙合)矫治治疗颞下颌关节紊乱病临床疗效分析

目的分析并评价矫治错(牙合)同时治疗颞下颌关节紊乱病(TMD)的临床效果.方法采用直丝弓技术矫治各种错(牙合)畸形伴TMD患者42例,详细记录治疗前、治疗6个月、治疗结束、治疗结束后2年的牙(牙合)情况及TMD症状、体征变化、颞下颌关节(TMJ)X线片情况.结果 30例患者TMD症状及体征基本痊愈,占71.4%;好转7例,占16.7%;无效或加重5例,占11.9%.结论错(牙合)畸形伴TMD的年轻患者经正畸矫治可以恢复咬合或作(牙合)重建,建立(牙合)平衡,使颞下颌关节、下颌回复到正常解剖位置.但已经发生器质性损害或TMJ解剖结构不对称的患者,治疗效果有待于进一步观察.     

颞下颌关节紊乱病症状、体征与患者生活质量的关系

目的定量分析颞下颌关节紊乱病（temporomandibulardisorders,TMD）症状、体征与患者生活质量的关系。方法连续选择初次就诊的TMD患者492例,自制“生活质量视觉模拟尺评估表”,计分评价TMD患者生活质量受影响程度。结果TMD对生活质量的影响主要表现在咀嚼、日常生活和情绪方面;单纯关节弹响对生活质量的影响最小;关节绞锁对生活质量的影响显著大于单纯关节弹响;重度和中度的疼痛、开口受限对生活质量的影响显著大于轻度的疼痛、开口受限。结论临床治疗应考虑TMD患者主诉症状对生活质量的影响程度。     

368例不同年龄段颞下颌关节盘穿孔患者的临床及锥形束CT分析

目的:探讨不同年龄段颞下颌关节盘穿孔患者的临床及锥形束CT(CBCT)特点.方法:收集在武汉大学口腔医院口腔颌面外科就诊的颞下颌关节盘穿孔患者的临床及CBCT资料,按年龄段分为6组,分析其临床和影像学特征,包括开口度、疼痛、关节杂音和咬合改变等.采用SPSS 26.0软件包进行统计学分析,比较不同年龄段患者的临床症状及...     

Long-term outcomes after treatment of condylar fracture by intraoral access: a functional and radiologic assessment.

PURPOSE: The aim of the present study was to investigate radiographic and functional long-term results after condylar fractures have been reduced by an exclusively intraoral surgical approach. PATIENTS AND METHODS: A total of 25 (21 male, 4 female) consecutive patients with 30 condylar process fractures were retrospectively investigated. Clinical follow-up was performed in 19 patients (16 male, 3 female) with a total of 24 fractures. Median postoperative follow-up time was 19.7 months. Surgical indications followed specific parameters of fracture localization, dislocation, and ramus shortening. All patients were examined in accordance with the Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) and the Helkimo Index. Orthopantomograms (OPGs) were analyzed with use of the condylar morphologic scale (CMS), and mandibular ramus position and height were measured. RESULTS: Fractures were classified as condylar neck (n = 2) and basis fractures (n = 28), according to criteria of the Strasbourg Osteosynthesis Research Group (SORG). Mean age of patients was 33 years (standard deviation [SD], 13 yr). RDC/TMD measurements at follow-up showed a mean mouth opening of 48 mm (SD, 9), mandibular laterotrusion right of 11 mm (SD, 3.8), laterotrusion left of 10 mm (SD, 4.5), and protrusion with a mean of 5.83 mm (SD, 3). No joint clicking, weakness of the facial nerve, or joint or muscular pain was observed. Statistical analysis of the CMS showed significantly better postoperative ramus height (P < .05). CONCLUSION: Reduction achieved by this technique allows reconstruction of anatomic ramus height in combination with excellent functional results.     

The relationship between jaw injury, third molar removal, and orthodontic treatment and TMD symptoms in university students in Japan

AIMS: To determine the association between temporomandibular disorders (TMD) and experiences of jaw injury, third molar removal, and orthodontic treatment, controlling for confounding factors such as age, sex, emotional stress, and oral parafunction. METHODS: First-year university students (n = 2,374) were instructed to answer a questionnaire regarding symptoms of TMD, jaw injury, third molar removal, orthodontic treatment, stress, and parafunctional habits. All subjects were classified according to the level of TMD symptoms. Logistic regression was applied to assess the associations of experiences of jaw injury, third molar removal, and orthodontic treatment with presence of TMD symptoms after controlling for age, sex, stress, and parafunctional habits. RESULTS: Of the 2,374 students, 715 students were TMD symptom-positive. They were classified into 7 groups consisting of those with only clicking (group 1), only pain in the temporomandibular joint (group 2), only difficulty in mouth opening (group 3), clicking and pain (group 4), clicking and difficulty in mouth opening (group 5), difficulty in mouth opening and pain (group 6), and all 3 symptoms (group 7). TMD symptoms were significantly associated with jaw injury. Odds ratios were 2.25, 2.47, 3.38, and 2.01 for groups 2, 3, 6, and 7, respectively. Experience of third molar removal was significantly associated with TMD (odds ratio = 1.81 for group 1). No association was found between orthodontic experience and TMD. CONCLUSION: Experiences of jaw injury and third molar removal might be cumulative and precipitating events in TMD.     

Signs and symptoms associated with TMD in adults with shortened dental arches

PURPOSE: This study investigated the prevalence of signs and symptoms associated with temporomandibular disorders (TMD) in adults with shortened dental arches in Tanzania. MATERIALS AND METHODS: The shortened dental arch group comprised 725 subjects with an intact anterior region and zero to eight occluding pairs of teeth posteriorly. They were categorized into five groups according to length and symmetry of the dental arches. A control group of 125 subjects with complete dental arches was included. The subjects were interviewed with questions related to pain and sounds within the temporomandibular joints and restricted mobility of the mandible. Clinical examination consisted of registration of clicking or crepitation of the joints, measuring maximum mouth opening, and assessing occlusal tooth wear. RESULTS: Joint sounds were reported significantly more frequently by subjects with posterior support only unilaterally (17%) and by subjects with no posterior support (10%) compared to other categories of dental arches (3% to 5%). No significant differences were found between categories of dental arches with respect to pain (2% to 9%), restricted mobility of the mandible (0% to 1%), maximum mouth opening < 40 mm (0% to 3%), or clicking or crepitation of the joints (12% to 23%). For the younger age group (> or = 20 and < 40 years), tooth wear occurred significantly more often in subjects with no posterior support. For the older age group (> or = 40 years), tooth wear increased significantly with decrease of posterior support. CONCLUSION: No evidence was found that shortened dental arches provoke signs and symptoms associated with TMD. However, when all posterior support is unilaterally or bilaterally absent, the risk for pain and joint sounds seems to increase.     

Chewing ability as a parameter for evaluating the disability of patients with temporomandibular disorders

Restoration of chewing ability is an important aspect of the treatment for temporomandibular disorders (TMDs). However, too little attention has been paid to it. We have used a questionnaire to evaluate and score the chewing ability of TMD patients. The questionnaire includes 19 kinds of food and a chewing task. The patient was asked if she/he experiences difficulty in enjoying eating. The aim of this study was to evaluate correlations between score of chewing ability (SCA) and other symptoms/signs of TMD. Four hundred and seventy-three consecutive TMD patients were evaluated for SCA and other symptoms/signs including temporomandibular joint (TMJ) pain, TMJ and muscle tenderness, TMJ noise (clicking and crepitus), and maximum mouth opening. The relationship between SCA and other symptoms/signs were analysed by multiple regression analysis. Score of chewing ability correlated significantly with TMJ pain and mouth opening capacity but not with TMJ noise and muscle tenderness. Age was a background factor but sex was not. The result of this study suggests that SCA correlated with dysfunction of the TMD patients. This method could be used to evaluate the ability of chewing in assessment of TMD.     

螺旋CT、锥形束CT与MRI在颞下颌关节紊乱病成像中的应用比较

目的 探讨螺旋CT（spiral CT）、锥形束CT(cone-beam CT, CBCT)与磁共振成像(magnetic resonance imaging,MRI)在颞下颌关节紊乱病（temporomandibular joint disorders, TMD）成像中的应用价值。方法 回顾分析104例208侧行螺旋CT、CBCT或MRI检查的临床怀疑TMD的患者。由2名放射科医师分别对每侧TMJ关节的关节间隙、关节盘的显示、髁突的骨质改变和关节腔积液情况进行评估,并将3组显示结果进行比较。采用SPSS19.0软件包对数据进行统计学分析。结果 除螺旋CT组与CBCT组右侧前间隙（P<0.05）及左侧上间隙有统计学差异（P<0.05）外,其余组比较均无统计学差异（P>0.05）。CBCT及螺旋CT无法清晰显示关节盘,而MRI对关节盘的显示率为100%。104例208侧TMJ中,通过同一样本资料不同检查的比较所示,螺旋CT与CBCT在显示髁突骨质改变上无统计学差异（P>0.05）,而螺旋CT、CBCT分别与MRI组比较均有统计学差异（P<0.05）。仅CBCT可清晰显示骨小梁结构。螺旋CT及CBCT均无法清晰显示关节腔积液,仅MRI可清晰观察,显示率为18.27%。结论 螺旋CT、CBCT及MRI对TMD都有一定的诊断价值。其中,MRI对关节盘的显示最好,并可显示骨髓的异常改变;CBCT、螺旋CT及MRI均可测量关节间隙,且螺旋CT、CBCT与MRI三者重建的关节各间隙影像基本一致;仅CBCT可以清晰显示髁突内骨小梁的结构及走行。     

Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders

The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20–60 yr of age) in a population‐based cross‐sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0–9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non‐painful subtypes of TMD.     

Mouse genetic models for temporomandibular joint development and disorders

The temporomandibular joint (TMJ) is a synovial joint essential for hinge and sliding movements of the mammalian jaw. Temporomandibular joint disorders (TMD) are dysregulations of the muscles or the TMJ in structure, function, and physiology, and result in pain, limited mandibular mobility, and TMJ noise and clicking. Although approximately 40–70% adults in the USA have at least one sign of TMD, the etiology of TMD remains largely unknown. Here, we highlight recent advances in our understanding of TMD in mouse models.     

稳定性牙合板治疗颞下颌关节紊乱病患者后髁突骨密度变化的CBCT研究

目的 利用CBCT测量颞下颌关节紊乱病(TMD)患者稳定性牙合板治疗前后髁突骨密度变化,分析稳定性牙合板对髁突改建的影响.方法 纳入40例稳定性牙合板治疗的TMD患者,治疗前后拍摄CBCT.运用MIMICS 21.0软件中Density功能测量髁突皮质骨密度,对髁突前斜面、顶部、后斜面骨密度进行统计学分析.结果 治疗前...