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.     

468例颞下颌关节紊乱病的诊治分析

颞下颌关节紊乱病(temporomandibular disorders，TMD)是一种常见病、多发病。由于颞下颌关节结构较复杂，口颌系统功能又多种多样，往往患病后造成患者生活与精神上的苦恼。本文对10年来诊治的468例TMD患者进行分析。     

颞下颌关节的超声成像特征及临床应用进展

颞下颌关节(temporomandibular joint, TMJ)是颌面部唯一的运动关节，其左右双侧对称且形态结构复杂。颞下颌关节紊乱病(temporomandibular joint disorder, TMD)好发于中青年，发病高峰为20～40岁，可累及10%～15%的成年人，是口腔颌面部的常见病和多发病。超声检查具有无创、无痛、经济、实时、便捷等优点，在颞下颌关节区疾病诊疗中的应用已受到国内外学者的广泛关注。因此，本文对颞下颌关节的超声成像特征及临床应用进展作一综述，以期探讨超声成像技术在实际临床工作中的应用方案。     

颞下颌关节软骨损伤治疗的进展

颞下颌关节(temporomandibular joint,TMJ)软骨损伤主要是指髁突和关节结节功能面的软骨损伤。病因复杂,表现为软骨内软骨细胞含量较低且增殖能力差,若治疗不当或治疗不及时,极易形成颞下颌关节病(temporomandibular disorder,TMD),最终出现不可扼制的逐步恶化,导致颞下颌关节骨关节病(temporomandibular joint osteoarthritis,TMJOA)的发生,以及关节功能的丧失。本文就其国内外研究现状及现有的治疗手段和疗效评价进行综述。1颞下颌关节软骨的解剖生理特点TMJ软骨主要分布于髁突和关节结节的表面,是继发性纤维软骨,组织学特点与其他…     

CBCT在义齿修复后颞下颌关节疾病诊治中的应用

目的 探讨锥形束CT (cone beam CT,CBCT)在义齿修复后颞下颌关节紊乱病(temporomandibular joint disorder,TMD)诊治中的应用效果.方法 20例义齿修复后出现TMD患者作为研究对象,进行CBCT检查,测定患者修复前后颞下颌关节(temporomandibular joi...     

颞下颌关节盘前移位病因研究进展

颞下颌关节盘前移位(temporomandibular joint anterior disc displacement, TMJ ADD)是临床上常见的一种颞下颌关节紊乱病(temporomandibular disorder, TMD),主要表现为疼痛、关节弹响和下颌运动受限,严重者影响日常生活。但其病因复杂,至今尚无统一结论,对其发病机制也缺乏明确而全面的认识。本文将对ADD的病因以及发病机制作一综述。     

正畸治疗中对颞下颌关节紊乱病的防治策略

颞下颌关节紊乱病（temporomandibular disorders,TMD）的病因复杂、发病率高,并且缺少治疗金标准。正畸治疗前及过程中若发生TMD,会增加治疗的难度与风险。文章从TMD的诊断、正畸治疗前TMD的筛查以及对正畸治疗期间可能诱发TMD的因素进行分析,为减少正畸治疗中TMD的发生提供临床参考。     

颞下颌关节紊乱病与心理因素的研究探讨

颞下颌关节紊乱病(temporomandibular disorder,TMD),是指颞下颌关节区疼痛、异常关节音及下颌运动功能障碍为主要特征而又不属于风湿等其他临床上或病理上诊断明确的一类颞下颌关节病的总称,作为口腔科的常见病,由于其分类和临床表现的多种多样,现在尽管存在有各种不同的学说和理论,但人们对其发病原因和机理一直尚未研究清楚.     

颞下颌关节紊乱指数临床应用评价

目的 探讨如何采用客观定量的方法评价颞下颌关节功能障碍程度和颞下颌关节紊乱病（temporomandibular disorders,TMD）的治疗效果。方法 分别采用Fricton颞下颌关节紊乱指数和Helkimo临床检查功能障碍指数，定量计算每例患者（共60例）的颞下颌关节紊乱指数，评价不同检查者获得的各项指数的一致性，并应用Fricton颞下颌关节紊乱指数定量评价TMD急性不可复性盘前移位的临床治疗效果。结果 （1）不同检查者获得的各项Fricton紊乱指数值相近；（2）Fricton紊乱指数可明确反映TMD急性不可复性盘前移位治疗后临床功能的改善。结论 评价TMD功能障碍程度或评价TMD治疗效果宜避免使用非客观的、描述性的报告，Fricton紊乱指数是一方便且有效的客观定量指标。     

超声诊断颞下颌关节紊乱病的研究

<正>颞下颌关节紊乱病(temporomandibular disorders,TMD)在青壮年中发病率较高,核磁共振(magneticresonance imaging,MRI)检查为诊断的金标准,但其费用高,耗时长。目前,超声检查以其无创、快速、廉价的优越性,成为更有效诊断TMD的手段。     

Clinical factors affecting the outcome of occlusal splint therapy of temporomandibular joint disorders

The purpose of this study was to test the hypothesis that (1) the presence of a clinical temporomandibular joint-related disorder has effects on short-term changes in temporomandibular joint pain, and that (2) clinical variables of time since pain onset predict treatment outcomes of occlusal splint therapy. The study comprised 76 patients with unilateral temporomandibular joint pain. The clinical disorder subgroup included 47 patients with a clinical pain side-related diagnosis of internal derangement type I (n = 16), internal derangement type III (n = 19), and degenerative joint disease (n = 12). The clinical non-disorder subgroup consisted of 29 patients without a temporomandibular joint disorder. A logistic regression analysis was used to compute the odds ratio for the clinical variables of time since pain onset, adjusted for age, gender, pretreatment pain level, and clinical subgroup. For the temporomandibular joint pain measurements there was no significant 'session'/'clinical subgroup' interaction (P = 0.470). Significant increase in benefit of a successful outcome of 'pain reduction >70%' occurred with a time since pain onset of 2 years might belong to the unsuccessful treatment group of 'pain reduction <30%' was strong (6.0) and significant (P = 0.026). Diagnosis of temporomandibular joint disorder proved not to be linked to changes in therapeutic outcome measures of temporomandibular joint pain. Time since pain onset was an important prognostic determinant of successful occlusal splint therapy.     

Characteristics of a jaw reflex in humans with temporomandibular disorders: a preliminary report

Electromyography was used to compare characteristics of an inhibitory jaw reflex in 10 temporomandibular disorder patients and 10 age- and sex-matched healthy controls. The methodology was novel in that the reflex was that evoked in the active masseter muscle, by electrical stimulation of perioral skin. This response has advantages over those previously studied as it avoids problems associated with stimulating in the moist intra-oral environment and it is monophasic, thus permitting easy quantification. The results have shown that (i) with the stimulation parameters employed, the reflex was present in all 10 control subjects, but in only eight of 10 temporomandibular disorder patients. (ii) When stimulation intensities were expressed as multiples of sensory threshold, there was no significant difference in the minimum level of stimulation required to evoke the reflex between the groups, although there was a trend for the patients with temporomandibular disorders to require higher intensities. (iii) Comparison of data from subjects giving responses at the same stimulus intensity (6 x sensory threshold: seven temporomandibular disorder patients, eight controls), showed no significant differences in the latencies or magnitudes of the reflex between the groups. However, the overall duration of the reflex was significantly shorter for the patients with temporomandibular disorders, with the reflex finishing significantly earlier. Thus even within the limitations of this study, it appears that an inhibitory jaw reflex evoked from stimulation around the mouth, may be weaker in temporomandibular disorder patients. This conclusion is consistent with previous studies on more complex jaw reflexes evoked by intra-oral stimuli.     

Prevalence of temporomandibular disorder pain,jaw noises and oral behaviours in an adult Italian population sample

To evaluate the prevalence of temporomandibular disorder pain (TMD‐pain), temporomandibular joint (TMJ) noises, oral behaviours in an Italian adult population sample, their possible association with gender, oral behaviours, self‐reported facial trauma and orthodontic treatment. Subjects older than 18 years were recruited from general population in public spaces during their daily life. A specific questionnaire was developed to collect data on TMD‐pain, TMJ noises, oral behaviours, orthodontic treatment and facial trauma. A total of 4299 subjects were included in the study. The most common symptom in the sample was TMJ clicking (30.7%), followed by TMD‐pain (16.3%) and TMJ crepitus (10.3%). Oral behaviours were reported in 29% of the sample; 43.6% of the sample reported a previous or ongoing orthodontic treatment. TMD‐pain and TMJ clicking were significantly associated to gender, oral behaviours and a positive history of previous facial trauma. Crepitus was significantly associated to oral behaviours, facial trauma and higher age. Ongoing orthodontic treatment was significantly associated to TMD‐pain and TMJ sounds. In a general Italian adult population sample, TMD‐pain is associated to female gender and is less prevalent than TMJ clicking. TMDs are associated to trauma and oral behaviours.     

偏侧咀嚼对大鼠颞下颌关节滑膜VEGF表达影响的研究

目的:研究偏侧咀嚼对大鼠颞下颌关节(TMJ)滑膜血管内皮细胞生长因子(VEGF)表达的影响。方法:30只大白鼠随机分为6组,实验组间断磨除右侧上、下颌磨牙牙冠至龈下,对照组未做处理,饲养条件相同。实验1组磨除牙冠后4周末、实验2、3组磨除牙冠后10、16周末处死动物,取其双侧TMJ切片免疫组化检测。结果:实验1、2、3组双侧颞下颌关节滑膜VEGF表达较对照组增强。结论:偏侧咀嚼可引起颞下颌关节滑膜损伤,VEGF参与了其病理过程。     

咬合干扰与颞下颌关节紊乱病的相关性研究

目的:通过临床检查分析安氏Ⅱ类1分类颞下颌关节紊乱(temporomandibular disorders,TMD)患者的咬合特点,探讨咬合干扰与颞下颌关节紊乱的相关性。方法:选取安氏Ⅱ类1分类TMD患者60例为实验组,无TMD安氏Ⅱ类1分类患者60例为对照组。采用目前国际上通用的视觉模拟尺分级评分测量法(visual analog scale VAS)对口面部不舒适程度进行评价;按照Fricton指数所包括的内容计算颞下颌功能障碍指数(temporomandibular dysfunction index DI),[DI=(MM+JN+JP)/26(0~1)],该指数包括下颌运动(MM)、关节杂音(JN)及关节压诊(JP)等。结果:实验组有咬合干扰者45例,对照组有咬合干扰者42例,二组间差异无显著性(P>0.05);实验组中存在咬合干扰的患者与无咬合干扰患者相比较,DI指数以及疼痛相关视觉模拟分数(VAS)均偏高,二者间差异有统计学意义(P<0.01),其中女性患者DI指数高于男性。结论:咬合干扰(occlusal interferences,OI)与TMD虽无直接联系,但OI与TMD共存可加重TMD患者临床症状,OI的存在对口颌系统的健康可能构成威胁。     

偏侧咀嚼对大鼠TMJ滑膜iNOS表达影响的研究

目的：研究偏侧咀嚼对大鼠颞下颌关节（TMJ）滑膜诱导型一氧化氮合酶（inducible nitric oxide synthase,iNOS）表达的影响。方法：30只大白鼠随机分为6组,实验1.2.3组,对照1.2.3组,每组5只。实验组间断磨除右侧上、下颌磨牙牙冠至龈下,对照组不做处理,饲养条件相同。分别于实验后4周、10周、16周末各处死实验组与对照组各1组动物,取其双侧TMJ切片免疫组化实验,与对照组比较。结果：实验1、2、3组双侧颞下颌关节滑膜iNOS表达增强。结论：偏侧咀嚼可引起颞下颌关节滑膜损伤,iNOS参与了其病理过程。     

Isolation and characterization of synovial cells from the human temporomandibular joint

BACKGROUND: The synovial tissues with temporomandibular disorders (TMDs) often show chronic inflammatory changes and the synovial cells participate in the pathogenic processes of TMDs. The synovial membrane is composed of a synovial lining layer and a connective sublining layer. The synovial lining layer is made up of two kinds of cells: macrophage-like type A and fibroblastic type B cells. The aim of this study was to isolate and characterize synovial cells from the human temporomandibular joint (TMJ). METHODS: Synovial cells were isolated using an explant culture method. Then, we characterized the cultured synovial cells (SGA2 cells) using immunocytochemistry. RESULTS: SGA2 cells expressed the fibroblastic markers vimentin and prolyl 4-hydroxylase; they also expressed laminin and heat shock protein 27, all of which are markers of type B cells. However, some cells expressed the macrophage marker CD68. These CD68-positive cells simultaneously expressed laminin. CONCLUSIONS: We isolated and cultured synovial type B cells from the human TMJ, and identified the presence of intermediate type synovial lining cells, having the phenotypic properties of both type A and type B cells, among the synovial lining cells.     

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随着锥形束CT在口腔颌面部应用的开展,锥形束CT也逐渐应用于颞下颌关节疾病的影像诊断中。本文介绍锥形束CT在颞下颌关节疾病中的应用现状,包括颞下颌关节紊乱病、颞下颌关节发育畸形、关节创伤、关节强直以及关节肿瘤等,结果表明锥形束CT作为一种有价值、有前途的影像检查方法,可以用于颞下颌关节疾病特别是关节骨性改变的评估中。     

Anxiety and personality traits in patients with muscle related temporomandibular disorders

This study tested the hypothesis that muscle related temporomandibular disorder patients with cervical muscle pain exhibit greater degree of psychological distress compared with patients without cervical muscle pain and controls. Thirty-eight muscle related temporomandibular disorder patients including 10 patients with cervical muscle pain and 41 healthy individuals as controls participated in the study. State and trait anxiety levels were assessed with the Spielberger's state and trait anxiety inventory. Personality traits (extroversion, neuroticism, psychoticism and social desirability) were assessed using the Eysenck's personality questionnaire, and the pain intensities described over the muscles were recorded using a 100 mm visual analogue scale. The muscle related temporomandibular disorder patients, in general, exhibited significantly higher degrees of neuroticism and trait anxiety. The patients with cervical muscle pain demonstrated a significantly higher level of psychoticism compared with the patients without cervical muscle pain and the controls and a significantly higher state anxiety level than the controls. They also demonstrated higher pain intensities in masseter and temporalis muscles compared with patients without cervical muscle pain. It has been suggested that either subjects with psychological distress are prone to temporomandibular disorders, or psychological distress is a manifestation of existing chronic pain conditions. The present findings demand further investigations and broader approach in management, as muscle related temporomandibular disorder patients with cervical muscle pain were both physically and psychologically compromised to a greater degree compared with patients without cervical muscle pain.     

医源性颞下颌关节紊乱征的临床治疗研究

目的 :对医源性颞下颌关节紊乱征进行综合治疗 ,观察其临床效果。方法 :根据医源性颞下颌关节紊乱征的临床症状及病因 ,采取不同的治疗方法 ,如修复牙列缺损、调整咬合、佩戴牙合垫、局部中药热敷及针灸治疗、按摩咀嚼肌和翼外肌 ,给予心理暗示和安慰等。结果 :综合治疗后 ,患者张口度得到明显改善 ,平均张口度从治疗前的 2 .13cm增大到 4.62cm (P <0 .0 1) ;患者痛苦感觉明显减轻 ,痛苦分值视觉模拟尺从治疗前的 7.3 6下降到2 .14 (P <0 .0 1)。结论 :医源性颞下颌关节紊乱征经过适当的治疗 ,可以改善关节状况 ,取得很好的临床疗效。