Influence of Mucosal Mechanoreceptors on Anterior Temporalis Emg Activity in Patients with Craniomandibular Dysfunction: A Preliminary Study

An analysis of saliva swallowing and tonic electromyographic (EMG) activity was undertaken in 15 young adult patients with craniomandibular dysfunction with and without a palatal base inserted. Recordings were performed by placing surface electrodes on the right and left anterior temporal muscles. Saliva swallowing and tonic activity were initially recorded with and without the palatal base inserted. After one week of continuous use of the palatal base, EMG activity was recorded again. Nonsignificant differences in EMG activity were observed in the studied conditions. EMG results do not support the therapeutical use of palatal base as a conservative and reversible treatment in patients with craniomandibular dysfunction.     

Influence of Stabilization Occlusal Splints on Sternocleidomastoid and Masseter Electromyographic Activity

The present work was conducted in order to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and masseter muscles, in subjects with tenderness to palpation in these muscles. A full-arch maxillary stabilization occlusal splint was made for each of 14 subjects. Tonic EMG activity, as well as during saliva swallowing and maximal voluntary clenching, was recorded with and without a stabilization occlusal splint inserted. Similar tonic, as well as maximal voluntary clenching EMG activity, with and without the stabilization occlusal splint, was observed. During saliva swallowing, the activity in both muscles was significantly lower with the stabilization occlusal splint. This suggests that daytime use of the stabilization occlusal splint might improve tenderness to palpation in the studied muscles, since the frequency of swallowing function is higher during waking hours.     

Effects of Head and Neck Inclination on Bilateral Sternocleidomastoid EMG Activity in Healthy Subjects and in Patients with Myogenic Cranio-Cervical-Mandibular Dysfunction

This study was conducted in order to determine the effect of head and neck position on bilateral electromyographic (EMG) activity of the sternocleidomastoid muscles. The study was performed on 16 patients with myogenic cranio-cervical-mandibular dysfunction (CMD) and 16 healthy subjects. EMG recordings at rest and during swallowing of saliva and maximal voluntary clenching were performed by placing surface electrodes on the right and left sternocleidomastoid muscles. EMG activity was recorded in the left lateral decubitus position, in a darkened room and with the individual's eyes closed, under the following experimental conditions: 1. Head, neck, and body horizontally aligned; 2. Head and neck upwardly inclined with respect to the body, simulating the effect of a thick pillow, 3. Head and neck downwardly inclined with respect to the body, simulating the effect of a thin pillow. Variation of head and neck positions was determined by measuring the distance from the angle of neck and shoulder and the apex of the shoulder (SND = shoulder—neck distance) of each individual. Then, head and neck were forward or downwardly inclined with respect to the body at one-third of SND. A significantly higher contralateral EMG activity and a more asymmetric EMG activity were observed in the CMD group than in the healthy subjects (Kruskal-Wallis Test).These results suggest a different behavior of bilateral sternocleidomastoid EMG activity in CMD patients than in healthy subjects depending on the positioning of the head and neck.     

Application of Soft Occlusal Splints in Patients Suffering from Clicking Temporomandibular Joints

This clinical study evaluated the application of prefabricated soft occlusal splints in 42 patients from a population of 84 patients with pain and dysfunction associated with clicking in the temporomandibular joints (TMJ).The soft occlusal splints were a temporary therapeutic and diagnostic modality for the relief of pain, dysfunction, and TMJ clicking over a 10- to 20-day-interim period between initial consultation and insertion of a custom-fabricated, full arch, hard acrylic, occlusal appliance or equilibration. The favorable results of this study support the use of the prefabricated, soft occlusal splints as a temporary treatment and diagnostic modality in patients suffering from reducible disk derangements of the temporomandibular joints.     

不同类型咬合板对颞下颌关节紊乱病疼痛患者咀嚼肌肌电的影响

目的:研究松弛型咬合板和稳定型咬合板对急慢性颞下颌关节紊乱病(TMD)疼痛患者颞肌前束(TA)、咬肌(MM)肌电的影响。方法:68例TMD疼痛患者分为急慢性2组,比较分析戴咬合板前和戴咬合板1个月后双侧TA和MM肌电电位。结果:戴板后静息状态下急慢性组患者双侧TA及MM肌电电位均较戴板前明显下降(P<0.05);紧咬状态下急性组戴松弛型咬合板患者双侧TA、MM肌电电位较戴板前明显上升,戴稳定型咬合板患者仅MM肌电电位较戴板前明显上升;慢性组戴松弛型和稳定型咬合板患者MM肌电电位均较戴板前明显上升(P<0.05)。结论:松弛型和稳定型咬合板均对咀嚼肌有松弛作用,松弛型咬合板更能明显缓解TMD急性患者肌紧张。     

Head Posture and Cervicovertebral and Craniofacial Morphology in Patients with Craniomandibular Dysfunction

A relationship between particular characteristics of dental occlusion and craniomandibular disorders (CMD) has been reported, while less attention has been focused on the possible effect of dysfunction of the masticatory system on head posture or cervicovertebral and craniofacial morphology. Natural head position roentgen-cephalograms of 16 young adults with complete dentition taken before and after stomatognathic treatment displayed an extended head posture, smaller size of the uppermost cervical vertebrae, decreased posterior to anterior face height ratio, and a flattened cranial base as compared with age-and sex-matched healthy controls. The lordosis of the cervical spine straightened after stomatognathic treatment. The results are an indication of the close interrelationship between the masticatory muscle system and the muscles supporting the head, and lead to speculation on the principles of treating craniomandibular disorders.     

Visual Input Effect on EMG Activity of Sternocleidomastoid and Masseter Muscles in Healthy Subjects and in Patients with Myogenic Cranio-Cervical-Mandibular Dysfunction

This study was conducted in order to determine the input visual effect on electromyographic (EMG) activity of the sternocleidomastoid and masseter muscles in the supine and lateral decubitus positions. The study was performed on 22 patients with myogenic cranio-cervical-mandibular dysfunction (CMD) and 18 healthy subjects. EMG activity at rest and during swallowing of saliva and maximal voluntary clenching was recorded in the supine and lateral decubitus positions in the following conditions: 1. with eyes open; and 2. with eyes closed after 5 minutes in a dark room. A significant decrease of EMG activity at rest with closed eyes in both groups was observed in the sternocleidomastoid (lateral decubitus position) and in the masseter muscle (supine position). During swallowing of saliva a significant decrease of EMG activity with closed eyes was observed only in the sternocleidomastoid muscle (lateral decubitus position) in healthy subjects. During maximal voluntary clenching any significant differences were observed upon variation in the visual input. The significant change in EMG activity, mainly observed at rest, suggests that the visual input effect is weak. The absence of a significant change in EMG activity during maximal voluntary clenching upon variation in the visual input could be clinically relevant in patients with myogenic CMD who habitually brux.     

Influence of Orofacial Dysfunctions on Spatial and Temporal Dimensions of Swallowing Movements

BACKGROUND AND AIM: Tongue dysfunctions are of etiologic significance for the development of malocclusions and speech disorders. Electromagnetic articulography is a means of recording orofacial movements. The aim of this study was therefore to analyze differences in the spatial and temporal sequence of swallowing movements under the influence of lip and tongue dysfunctions in order to develop new means of objectifying the diagnosis of such a dysfunction. PATIENTS AND METHOD: Thirty-one subjects were monitored during reflex swallowing and while swallowing 20 ml of water. All probands also underwent evaluation by a speech pathologist as well as palatography. The entire cohort was then divided into a viscerally and a somatically swallowing group, and the movement sequences were analyzed with reference to spatial and temporal parameters. RESULTS: The temporal parameters revealed fewer significant differences than the spatial parameters. Most differences were recorded for the section between palate separation point and end of swallowing. Specific spatial or temporal variables revealing a maximum number of differences between the two groups were found for each tongue region. Swallowing water revealed notably more significant intergroup differences. The most suitable variables during the swallowing of water were the maximum distance of tongue-palate contact and the distance or time interval between palate separation point and end of swallowing. CONCLUSION: The analysis of swallowing movements by electromagnetic articulography offers opportunities to evaluate tongue dysfunctions. The most suitable combination of variables was found for each of the regions investigated. Spatial analysis of the movement pattern seems to be the most reliable method.     

牙周炎患者唾液GSH-PX活性的检测

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Blocking of Periodontal Afferents with Anesthesia and Its Influence on Elevator EMG Activity

The effect of anesthetic blocking of the periodontal afferents of the canine teeth was studied in order to determine its influence on any changes in the jaw elevation activity. Unilateral integrated EMG recordings were made of the masseter and anterior temporal muscles during maximal voluntary clenching in centric occlusion and laterotrusive position with canine contact. After anesthetic blocking of the periodontal afferents of one or both ipsilateral canines, a significant increase was observed of the EMG activity of both jaw elevator muscles studied, in centric occlusion as well as with canine contact. The elevator activity increase was of a greater magnitude when antagonistic canines were anesthetized. These findings thus support the hypothesis that high threshold periodontal receptors exert an inhibitory effect on jaw elevator muscular activity.     

颅下颌紊乱病患者髁突长轴水平角的测量观察

在１２４例颅下颌紊乱病患者的颏顶位颅底平片上测量了髁突长轴水平角，以了解Ｘ线片上髁突长轴水平角的人群分布规律，以及与颅下颌关节病变严重程度的关系。本组髁突长轴水平角均值为１５．１４°；左右侧之间、男女之间以及４０岁前与４０岁后的角度均值相比较均无显著性差异（Ｐ＞０．０５）。男性患者右侧关节患骨性病变时的髁突长轴水平角较右侧关节患非骨性病变时为大（Ｐ＜０．０５）。提示髁突长轴水平角的增大可预示病变的严重程度     

下颌前移矫正器对阻塞性睡眠呼吸暂停综合征患者上气道影响的X线研究

目的研究下颌前移矫正器对阻塞性睡眠呼吸暂停综合征(OSAS)患者上气道的影响及与颅面形态的关系.方法148名存在0SAS的北欧白人患者拍摄治疗前及戴用矫正器后的自然头位时X线头颅侧位片.计算机头影测量进行21项项目的测量.比较戴入矫正器前后头影测量的变化.统计分析为配对t检验和多因素逐步回归,由SPSS软件包完成.结果戴入矫正器后患者上气道矢状径在各水平均增加,腭咽水平(SAS)增加1.76±2.03mm;舌咽水平(PAS)增加了1.77±2.03mm,喉咽水平(LAS)增加了1.08±0.97mm.在女性组,SAS的增加与戴矫正器后前牙打开的高度负相关(R2=0.174);PAS的增加与髁突前移的距离相关(R2=0.31);总样本中LAS的变化与软腭长度负相关与覆盖的减小相关(R2=0.67);女性中LAS与下颌前移量相关(R2=0.194).结论下颌前移矫正器能增加患者上气道的宽度,变化最显著者在气道口咽部.气道宽度的变化与患者颅面特征相关.     

Prevalence and Patterns of Nocturnal Bruxofacets on Stabilization Splints in Temporomandibular Disorder Patients

The purpose of this study was to investigate the prevalence of nocturnal bruxism, the characteristics of bruxofacets, and the reduction of symptoms in temporomandibular disorder (TMD) patients. The study involved the observation of bruxofacets on a stabilization splint. Twenty-six patients (22 women and 4 men, 16–54 years of age) with signs and symptoms of TMD were given an initial examination before using a splint, and then at intervals of one, three, six and ten weeks after a stabilization splint was first used. In 88% of the patients (n=23) active shiny facets or scratches caused by nocturnal bruxism appeared on the occlusal surface of splints within ten weeks. In 52% of the 23 patients these facets were created by bilateral mandibular excursions, in 35% by small lateral movements, and in 13% by unilateral excursions. Subjective pain and the Craniomandibular Index in patients had decreased after ten weeks (p<0.001), but a reduction of symptoms did not differ according to the patterns of the bruxofacets. It was concluded that most TMD patients have a parafunctional habit, namely bruxism. Further research is needed to produce more convincing evidence of a true cause-and-effect relationship between nocturnal bruxism and TMD.     

磨牙症患者牙合磨损特征的研究

目的 观察磨牙症患者He磨损的部位与程度，分析磨牙运动的特征及相关的影响因素。方法 对64名磨牙症患者进行检查及模型分析。对每个牙磨损程度与部位进行评分比较。结果 左右同名牙磨损无差异。上下同名牙磨损不完全相同；尖牙的磨损最严重；侧方磨动所致的磨损远远大于前伸磨动所致的磨损；牙弓的中段磨损最严重。结论 磨牙运动主要以侧方运动为主，以尖牙磨损最严重，尖牙磨损对磨牙症的发生发展是一重要的促进因素。     

咬合重建对牙齿重度磨耗患者咀嚼运动模式的影响

目的探讨咬合重建修复对不同类型的牙齿重度磨耗患者咀嚼运动模式的影响。方法选择29例牙齿重度磨耗进行咬合重建修复的患者,根据后牙咬合支持状态分成后牙支持完全组（试验Ⅰ组,15例）和后牙支持不全组（试验Ⅱ组,14例）,分别测量修复前、过渡修复1个月及永久修复1个月后咀嚼运动时嚼肌、颞肌前束和颞肌后束的表面肌电图,并选择15例正常人作为对照组,分析咀嚼周期、咀嚼运动活动期与间歇期比值及肌电积分值的变化。结果修复前,试验Ⅰ组和Ⅱ组患者的咀嚼周期与对照组之间无统计学差异（P>0.05）;试验Ⅱ组活动期与间歇期比值明显高于对照组,而颞肌前束的肌电积分值低于对照组（P<0.05）。过渡修复及永久修复后,试验Ⅰ组和Ⅱ组的咀嚼周期有逐步缩短的趋势。过渡修复时,Ⅰ组患者活动期与间歇期比值和肌电积分值较修复前均有下降（P<0.05）;Ⅱ组患者活动期与间歇期比值较修复前下降（P<0.05）,肌电积分值的变化则不明显（P>0.05）。永久修复后,Ⅰ组患者活动期与间歇期比值和肌电积分值较过渡修复时的变化均无统计学意义（P>0.05）;Ⅱ组患者活动期与间歇期比值较过渡修复时进一步下降,肌电积分值则明显提高（P<0.01）。结论咬合重建修复能明显改善重度磨耗患者咀嚼运动循环模式,提高咀嚼肌活动强度。     

口腔癌患者唾液中透明质酸含量的检测及意义

目的:检测口腔癌患者唾液中透明质酸(HA)的含量,探讨HA对口腔癌辅助诊断和治疗效果监测的价值。方法:选择住院治疗的口腔癌患者36例,健康人20例,采用酶联免疫吸附试验法(ELISA)测定所有标本唾液中的HA浓度。结果:治疗前口腔癌患者唾液中HA含量显著高于健康人(P<0.05),治疗后口腔癌患者唾液中HA含量低于治疗前,但差异不显著(P>0.05)。结论:唾液中HA含量测定对口腔癌可能有辅助诊断价值。唾液中HA的含量变化可作为判断肿瘤预后的参考,但不能用于治疗效果的监测。     

预成[牙合]垫治疗肌筋膜疼痛的短期疗效观察

目的：用随机对照试验比较稳定型[牙合]垫与预成[牙合]垫治疗肌筋膜疼痛患者的短期疗效。方法：2个中心的60名患者被分配到稳定型[牙合]垫（S组,n=33）或预成[牙合]垫组（R组．n=32）。患者均罹患颞下颌关节紊乱病（TMD）疼痛,持续时间为3个月至40年不等。用RDC／TMD诊断标准对患者进行症状和体征的检查．指定一名全科医师进行治疗。疼痛治疗的结果用视觉模拟刻度尺来评价．在6周和10周随访时并让患者对疼痛缓解进行语言评价,其组间数据运用统计学方法进行比较。结果：[牙合]垫治疗结果均使症状改善．第6周和第10周的随访结果两组间没有任何统计学差异。在6周的随访中．72％的患者疼痛减轻30％．55％的患者疼痛减轻50％,而在10周的随访中,该百分比分别为69％和61％。根据患者语言评价,在6周随访时,85％的患者汇报自己是“较好”、”好得多”或“无症状”．在10周随访时该数据为83％。结论：预成[牙合]垫与稳定型骀垫基本上有相同功效。因此．可以将预成[牙合]垫作为治疗成年肌筋膜疼痛患者的一种短期疗法。     

口腔颌面部恶性肿瘤患者唾液氨基酸测定

本研究采用高效液相色谱法对21例口腔颌面部恶性肿瘤患者和47例正常人进行唾液氨基酸测定.结果表明,唾液中16种游离氨基酸含量恶性肿瘤组明显高于对照组(P<0.01).初步提示,唾液氨基酸含量变化可能对口腔颌面部恶性肿瘤的诊断有参考价值.