MRI在诊断颞下颌关节紊乱病及评价RW咬合板治疗效果中的应用

目的研究颞下颌关节紊乱病（TMD）患者的磁共振成像（MRI）特征,探讨MRI在评价RW咬合板（RW-splint）治疗效果中的应用价值。 方法收集经临床确诊并行MRI检查的TMD患者32例,回顾性分析32例患者共64侧颞下颌关节的MRI图像,总结TMD的MRI特征;其中21例患者进行RW咬合板治疗,治疗前、后均行MRI扫描,测量关节盘-髁突角度及关节盘长度并进行统计学分析。 结果64侧颞下颌关节中,46侧关节盘形态异常,其中可复性前移位21侧、不可复性前移位25侧;46侧髁突均可见不同程度骨质增生、骨皮质缺损,其中13侧髁突运动过度、5侧髁突运动受限;10侧关节腔内可见积液。21例患者RW-splint治疗后,可复性前移位患侧关节盘-髁突角度由（25.7 ± 2.6）°减小至（19.1 ± 1.6）°;关节盘长度（11.1 ± 1.3）mm缩短至（9.1 ± 0.7）mm,治疗前、后患侧关节盘-髁突角度及关节盘长度变化差异均具有统计学意义（t_角度= 2.889,P_角度= 0.014;t_长度= 2.354,P_长度= 0.023）;不可复性前移位患侧盘突角度由（26.4 ± 2.3）°减小至（24.1 ± 2.1）°,关节盘长度（12.0 ± 1.3）mm缩短至（11.9 ± 1.2）mm,治疗前后患侧关节盘-髁突角度、关节盘长度变化差异均无统计学意义（t_角度= 1.897,P_角度= 0.082;t_长度= 1.076,P_长度= 0.124）。 结论MRI不仅能够无创、准确诊断TMD,而且能够客观评价RW-splint治疗效果。     

促红细胞生成素对人牙髓细胞迁移能力的作用

目的研究促红细胞生成素（EPO）对人牙髓细胞（hDPC）迁移能力的影响,并初步探讨相关分子机制。 方法实时荧光定量聚合链反应（PCR）检测EPO对hDPC表达趋化因子mRNA的影响;Transwell实验观察不同浓度的EPO对hDPC迁移能力的影响;Western blot检测不同时间点hDPC中p38、ERK1/2、JNK磷酸化水平的变化;细胞划痕实验观察丝裂原活化蛋白激酶（MAPK）信号通路抑制剂对EPO诱导hDPC迁移的影响。 结果EPO上调趋化因子CXCR4、SDF-1 mRNA的表达（t_CXCR4= 5.727,P_CXCR4= 0.005;t_SDF-1= 3.412,P_SDF-1= 0.027）;与对照组相比,EPO显著促进hDPC的迁移能力（F= 207.775,P_{10 U/ml}= 0.000,P_{20 U/ml}= 0.000,P_{40 U/ml}= 0.000）;EPO可升高MAPK信号通路中关键蛋白ERK1/2（t_{15 min}= 6.554,P_{15 min}= 0.000;t_{30 min}= 17.305,P_{30 min}= 0.000;t_{60 min}= 8.913,P_{60 min}= 0.000;t_{120 min}=-5.896,P_{120 min}= 0.934）和p38的磷酸化程度（t_{15 min}= 4.396,P_{15 min}= 0.004;t_{30 min}= 6.447,P_{30 min}= 0.000;t_{60 min}= 34.676,P_{60 min}= 0.000;t_{120 min}= 4.689,P_{120 min}= 0.003）;MAPK信号通路抑制剂U0126、SB203580可抑制EPO诱导的hDPC迁移（t_EPO-U0126= 2.422,P_{EPO- U0126}= 0.025;t_EPO-SB203580= 3.837,P_EPO-SB203580= 0.001）。 结论EPO上调趋化因子CXCR4和SDF-1 mRNA的表达,通过激活MAPK信号通路,促进hDPC迁移。     

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。     

A型肉毒毒素复合罗哌卡因治疗三叉神经痛的疗效

目的评价A型肉毒毒素（BTX-A）复合罗哌卡因治疗特发性三叉神经痛的临床效果。 方法选取2018年12月至2019年10月在中国医科大学附属口腔医院就诊的特发性三叉神经第三支疼痛患者20例，随机数字表法分为试验组、对照组，每组10例。试验组采用BTX-A复合罗哌卡因治疗，对照组采用卡马西平治疗。两组治疗前及治疗后1 h、6 h、12 h、1周、1个月、3个月和6个月行视觉模拟量表（VAS）评分比较疼痛程度，同时统计和比较疼痛发作频率及睡眠质量，进行疗效评价。使用SPSS 20.0软件进行数据分析。 结果试验组疼痛VAS评分在治疗后1 h、1个月分别为0.4 ± 0.5和2.8 ± 3.1，分别低于对照组（1.2 ± 1.0、5.1 ± 1.4），差异均有统计学意义（t_{1 h}=-2.191，P_{1 h}= 0.047；t_1个月=-2.155，P_1个月= 0.045）；试验组治疗后1个月睡眠质量评分为7.8 ± 3.2，对照组为10.8 ± 2.4，差异有统计学意义（t=-2.395，P= 0.028）；试验组疼痛发作频率在治疗后1周、1个月、3个月均低于对照组，而在治疗后6个月高于对照组，差异均有统计学意义（t_1周=-2.900，P_1周= 0.010；t_1个月= -4.544，P_1个月= 0.001；t_3个月=-5.156，P_3个月= 0.000；t_6个月= 3.391，P_6个月= 0.003）。 结论BTX-A复合罗哌卡因可缓解特发性三叉神经痛，改善患者的睡眠状况。     

转化生长因子β1增强糖酵解促进舌鳞状细胞癌细胞上皮间充质转化及迁移与侵袭

目的研究转化生长因子β1（TGF-β1）对舌鳞状细胞癌（TSCC）糖酵解活性和上皮间充质转化（EMT）及迁移与侵袭的影响。 方法利用10 ng/mL TGF-β1处理TSCC SCC9细胞1、2、3 d,收集细胞上清液检测葡萄糖和乳酸表达变化;蛋白免疫印迹法（Western blot）检测TGF-β1处理1、2、3 d后糖酵解关键酶表达变化;应用10 ng/mL TGF-β1处理TSCC SCC9细胞2、4、6 d,在倒置显微镜下定时观察细胞形态;Western blot检测TGF-β1诱导2、4、6 d后EMT上皮标记蛋白E-cadherin、间质标记蛋白Vimentin、Snail和Slug的表达变化;Transwell小室检测细胞迁移和侵袭能力;同等培养条件下未经TGF-β1处理的为对照组。SPSS 13.0统计软件进行数据分析。 结果在TGF-β1诱导条件下,TSCC SCC9细胞葡萄糖摄取量在2和3 d时[（34.1 ± 1.2）、（47.1 ± 2.3）mmol]较对照组显著升高（t_{2 d}= 17.941,P_{2 d}= 0.003;t_{3 d}= 24.430,P_{3 d}= 0.002）,同时SCC9细胞乳酸生成量在2和3 d时[（46.4 ± 1.0）、（60.2 ± 2.0）mmol]较对照组明显增加（t_{2 d}= 50.230,P_{2 d}= 0.005;t_{3 d}= 26.883,P_{3 d}= 0.004）;TGF-β1处理后,糖酵解关键酶HK2表达在2和3 d时（1.21 ± 0.04、1.30 ± 0.06）均高于对照组,差异有统计学意义（t_2d= 6.111,P_{2 d}= 0.026;t_{3 d}= 6.423,P_{3 d}= 0.023）;糖酵解关键酶PKM2表达在2和3 d时（1.048 ± 0.002、1.071 ± 0.010）与对照组相比,差异无统计学意义（t_{2 d}= 20.693,P_{2 d}= 0.072;t_{3 d}= 9.875,P_{3 d}= 0.081）;糖酵解关键酶PFKP在2和3 d时（0.820 ± 0.010、0.839 ± 0.036）表达较对照组明显升高（t_{2 d}= 21.829,P_{2 d}= 0.020;t_{3 d}= 9.853,P_{3 d}= 0.022）;糖酵解关键酶GLUT1表达在2和3 d时（0.503 ± 0.007、0.589 ± 0.019）均高于对照,差异具有统计学意义（t_{2 d}= 30.693,P_{2 d}= 0.015;t_{3 d}= 21.173,P_{3 d}= 0.012）。在TGF-β1诱导下,与对照组相比,TSCC SCC9细胞从鹅卵石状变为长梭形,同时EMT上皮标记蛋白E-cadherin表达在2、4和6 d时（0.69 ± 0.03、0.67 ± 0.04、0.65 ± 0.04）较对照组降低,差异有统计学意义（t_{2 d}= 7.187,P_{2 d}= 0.019;t_{4 d}= 6.631,P_{4 d}= 0.022;t_{6 d}= 6.690,P_{6 d}= 0.022）,间质标记蛋白Vimentin（1.089 ± 0.134、0.706 ± 0.025、0.620 ± 0.010）表达在2、4、6 d处与对照组相比表达升高（t_{2 d}= 6.948,P_{2 d}= 0.020;t_{4 d}= 16.710,P_{4 d}= 0.004;t_{6 d}= 6.157,P_{6 d}= 0.025）,EMT转录因子snail在2 d时（1.14 ± 0.17）表达与对照组（0.77 ± 0.10）相比表达升高（t= 3.794,P= 0.015）,EMT转录因子slug在2 d时（1.85 ± 0.11）表达与对照组（0.93 ± 0.02）相比表达升高（t= 15.385,P= 0.014）;与对照组（20.0 ± 2.0）相比,TGF-β1处理后细胞迁移能力（45.7 ± 11.6）显著增加（t= 4.529,P= 0.017）,细胞侵袭能力（58.7 ± 5.0）较对照组（22.3 ± 1.5）明显升高（t= 15.571,P= 0.015）。 结论TGF-β1增强糖酵解,并促进TSCC细胞EMT及迁移和侵袭。     

古曲抑菌素A对脂多糖诱导人牙髓细胞炎症反应的影响

目的研究组蛋白去乙酰化酶抑制剂曲古抑菌素A（TSA）对脂多糖（LPS）诱导人牙髓细胞（hDPC）炎症反应的影响。 方法采用酶组织块法体外分离培养hPDC,按处理因素不同分为空白对照组、LPS组（1 μg/ml）、TSA（25或50 nmol/L预处理）+LPS（1 μg/ml）组,实时荧光定量聚合酶链反应（PCR）和ELISA检测促炎因子白细胞介素（IL）-6、IL-8 mRNA及蛋白表达量,Western blot检测NF-κB信号通路关键信号蛋白IKKα/β、p65及IκB-α磷酸化程度的变化。IL-6、IL-8 mRNA及蛋白表达采用方差分析,NF-κB信号通路Western blot结果采用独立样本t检验。 结果TSA（25 nmol/L）预处理能显著降低LPS刺激引起的IL-6、IL-8 mRNA与蛋白表达（F_{IL-6 mRNA}= 22.538,P_{IL-6 mRNA}= 0.002;F_{IL-8 mRNA}= 20.253,P_{IL-8 mRNA}= 0.002;F_IL-6蛋白= 9.327,P_IL-6蛋白= 0.007;F_IL-8蛋白= 9.6894,P_IL-8蛋白= 0.011）;LPS刺激能激活NF-κB信号通路中关键蛋白p-IKKα/β、p-p65和p-IκB-α的表达,而TSA预处理可降低IKKα/β（t_{30 min}= 6.437,P_{30 min}= 0.003;t_{60 min}= 6.386,P_{60 min}= 0.003;t_{120 min}= 4.368,P_{120 min}= 0.012）和IκB-α磷酸化程度（t_{15 min}= 3.822,P_{15 min}= 0.019;t_{30 min}= 4.467,P_{30 min}= 0.011）。 结论TSA可显著抑制LPS刺激下hDPC促炎因子的分泌,同时降低IKKα/β和IκB-α磷酸化程度,提示TSA可能通过降低NF-κB信号通路活性抑制牙髓炎症发展。     

云南地区人群下颌第一前磨牙、第二前磨牙和第一恒磨牙根管解剖形态的锥形束CT分析

目的利用锥形束CT（CBCT）分析云南地区人群下颌第一前磨牙、第二前磨牙和第一恒磨牙根管解剖形态,为临床根管治疗提供理论依据和参考。 方法根据年龄（20 ~ 29岁、30 ~ 39岁、40 ~ 49岁、50 ~ 59岁）分层抽取2017年1月至2018年1月在昆明医科大学附属口腔医院放射科进行CBCT检查的患者的数据资料各100例。400例患者中有324例CBCT数据资料符合标准,其中男166例、女158例,年龄20 ~ 29岁82例、30 ~ 39岁82例、40 ~ 49岁82例、50 ~ 59岁78例。统计分析下颌第一前磨牙、第二前磨牙和第一恒磨牙的根管数目、根管长度和根管弯曲度,并对不同年龄段根管长度、下颌第一磨牙牙尖到根分叉距离及根尖孔到下颌神经管距离数据进行单因素方差分析,对不同性别下颌第一磨牙牙尖到根分叉距离及根尖孔到下颌神经管距离数据进行独立样本t检验。 结果通过对324例患者CBCT影像资料的分析得出,下颌前磨牙基本为单根管（647/648颗）,仅见1例右下第一前磨牙双根管。下颌前磨牙弯曲度以一级弯曲（5° ~ 10°）和二级弯曲（10° ~ 25°）为主,前磨牙根管长度大多处于正常范围（15 ~ 25 mm）,下颌第一恒磨牙弯曲度近远中根均以二级弯曲（10° ~ 25°）为主,下颌第一恒磨牙牙尖到根分叉的距离随年龄增长变短（F_左侧=11.16,P_左侧<0.001;F_右侧=11.51,P_右侧<0.001）,男女性别差异无统计学意义（t_左侧=1.31,P_左侧=0.19;t_右侧=0.51,P_右侧=0.61）;下颌第一恒磨牙根尖孔到下颌神经管的距离随年龄增长变长（F_左侧=7.03,P_左侧<0.001;F_右侧=12.25,P_右侧<0.001）,男女性别差异无统计学意义（t_左侧=-0.64,P_左侧=0.52;t_右侧=-0.11,P_右侧=0.91）。 结论本研究中云南地区人群下颌前磨牙根管解剖形态相对简单;下颌第一恒磨牙根管解剖形态复杂,云南地区人群下颌前磨牙、第一恒磨牙根管解剖系统与其他地区相比有所差异,但增龄性变化无区别,CBCT可为临床根管治疗提供依据。     

颞下颌关节紊乱病患者轴Ⅱ测评临床调查研究

目的通过颞下颌关节紊乱病诊断标准(diagnostic criteria for temporomandibular disorders,DC/TMD)的轴Ⅱ评价量表调查,筛查引发TMD的身体、心理及行为因素,为临床制订个性化诊疗方案及疾病预防提供参考。方法选择2018年10月至2021年2月就诊于武汉大学口腔医学院口腔颌面外科颞下颌关节门诊的TMD患者141例(TMD组),其中女性121例,男性20例,平均年龄30岁;2021年1至2月于武汉市在校大学生、教师、公职人员等人群中招募普通健康者90名作为对照组,其中女性66名,男性24名,平均年龄30岁。对所有受试者进行问卷调查,问卷包括一般状况调查表和TMD症状问卷;轴Ⅱ评价量表包括:慢性疼痛等级量表、下颌功能受限量表、口腔行为检查、患者健康问卷-9(抑郁情绪)、广泛性焦虑症量表、患者健康问卷-15(躯体化症状)等评价量表。主要观察指标包括疼痛程度、疼痛对患者影响分级、慢性疼痛整体分级、下颌功能受限量表指标得分、抑郁得分、焦虑得分、躯体化症状得分和口腔行为得分。比较TMD组不同诊断患者之间轴Ⅱ各量表评价指标的差异。结果TMD组具有不同程度疼痛的患者占60.3%(85/141);疼痛影响分级1~3级者占24.1%(34/141);慢性疼痛整体分级为Ⅰ~Ⅳ级者占61.0%(86/141)。TMD组咀嚼功能受限、运动功能受限、交流功能受限及总体下颌功能受限得分均显著高于对照组(P<0.05)。TMD组轻度抑郁以上患者占59.6%(84/141),轻度焦虑以上患者占56.7%(80/141),46.1%(65/141)患者有躯体化症状。TMD组患者的等级分布均显著高于对照组(P<0.05)。颞下颌关节骨关节病和关节半脱位患者中出现躯体化症状者显著多于关节盘移位患者(P<0.05)。TMD组内不同的慢性疼痛状态分级之间在下颌功能障碍各指标以及抑郁、焦虑和躯体化症状等方面差异均有统计学意义(P<0.05)。结论TMD患者比普通健康人口腔行为异常增加,下颌功能活动受到不同程度的限制,同时抑郁、焦虑情绪以及躯体化症状方面更严重。颞下颌关节骨关节病和关节半脱位患者更易出现躯体化症状。TMD患者伴有疼痛症状者下颌功能障碍受限及抑郁、焦虑和躯体化方面症状较重。     

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。     

改良迷你临床演练方法在口腔正畸科考核中的初步应用

目的探讨将Tweed分析法与迷你临床演练（Mini-CEX）相结合,建立适用于口腔正畸专科的临床考核方案的效果。 方法通过将Mini-CEX方法与正畸学Tweed分析表进行结合,并补充细化评分表,从而建立了一种新型口腔正畸学教学考核方法,称为改良Mini-CEX考核。于2019年9月,从上海交通大学医学院附属第九人民医院口腔正畸科随机选取6名在培口腔专科培训医师作为考生,对考生进行改良Mini-CEX考核,由5名正畸专家对其表现进行打分。应用SPSS 21.0软件对打分结果进行统计,计算肯德尔和谐系数（W）并进行显著性检验。 结果不同考官在评价同一考生时,考官间的打分具有显著的一致性（W₁ = 0.742,P₁ = 0.001;W₂ = 0.666,P₂ = 0.003;W₃ = 0.720,P₃ = 0.001;W₄ = 0.628,P₄ = 0.004;W₅ = 0.555,P₅ = 0.011;W₆ = 0.330,P₆ = 0.1293）。在医疗面谈、体格检查、临床判断、卫生教育、组织效能和整体表现6项,打分具有显著的一致性（W₁ = 0.620,P₁ = 0.008;W₂ = 0.588,P₂ = 0.012;W₃ = 0.885,P₃<0.001;W₄ = 0.625,P₄ = 0.008;W₅ = 0.835,P₅ = 0.001;W₆ = 0.930,P₆<0.001）,仅人文关怀一项未通过一致性检验（W = 0.147,P = 0.598）。 结论改良Mini-CEX具有标准程序,建立明确的得分细节,可以考核全面、获得公正客观,在不同考官间具有良好一致性,适用于当前口腔正畸学的考核与评价。     

颞下颌关节紊乱病患者的症状自评量表调查

目的通过对颞下颌关节紊乱病（TMD）患者的症状自评量表（SCL-90）各因子进行分析，了解其精神心理状态。方法338例就诊于北京大学口腔医学院颞下颌关节病及口颌面痛诊治中心的TMD患者填写SCL-90，采用t检验和单组设计定量资料的多元方差分析，将患者和普通人群的SCL-90各因子得分进行比较。结果①TMD患者SCL-90中的躯体化、强迫、焦虑、敌意、恐怖、精神病性因子得分高于普通人群，差异有统计学意义（P〈0．05）；②伴有精神心理障碍的TMD患者比例为23％；③对338份患者SCL-90进行可靠性分析，得出可靠系数为0．958。结论我国TMD患者的精神心理障碍问题不容忽视。SCL-90作为判断TMD患者是否伴有某些精神心理障碍的量表，在我国同样具有较好的适用性。     

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.     

Glutamate-evoked jaw muscle pain as a model of persistent myofascial TMD pain?

OBJECTIVE: Compare pain-related measures and psychosocial variables between glutamate-evoked jaw muscle pain in healthy subjects (HS) and patients with persistent myofascial temporomandibular disorder (TMD) pain. DESIGN: Forty-seven female HS and 10 female patients with persistent myofascial TMD pain participated. The HS received an injection of glutamate into the masseter muscle to model persistent myofascial TMD pain. Participants filled out a coping strategies questionnaire (CSQ), the symptom checklist 90 (SCL-90) and McGill pain questionnaire (MPQ). Pain intensity was assessed on an electronic visual analogue scale (VAS). Pain-drawing areas, numerical rating scale (NRS) scores of unpleasantness, pressure pain thresholds (PPTs) and pressure pain tolerance (PPTOL) were measured. Unpaired t-tests and correlation tests were used for analyses. RESULTS: The groups were significantly different when comparing the CSQ scores of control, decrease, diverting attention, increase of behavioural activities and somatization. The peak VAS pain, NRS of unpleasantness and MPQ scores were not significantly different between groups, but PPT and PPTOL were significantly lower in the TMD patients. Significant positive correlations were found in the TMD patients between peak VAS pain and CSQ catastrophizing score and SCL-90 somatization. The scores of PPTs and PPTOLs, in patients showed positive correlations with CSQ reinterpreting pain sensations scores and PPTs correlated with CSQ praying/hoping scores. CONCLUSIONS: Glutamate-evoked pain responses in HS and persistent myofascial TMD pain have similar sensory-discriminative and affective-unpleasantness components but differ in psychosocial features. This study suggests that experimental designs based on glutamate injection into muscle can provide an appropriate model for elucidating persistent myofascial pain conditions.     

Psychosocial profiles of painful TMD patients

Summary  The aim of the present investigation is to test the null hypothesis that the presence of psychopathology in patients with temporomandibular disorders (TMD) is related to the presence of pain, independent of its location [(i.e. myofascial and/or temporomandibular joint (TMJ) pain]. Ninety-six ( n  = 96) patients affected by painful TMD underwent a clinical assessment in accordance with the research diagnostic criteria for TMD (RDC/TMD) guidelines and filled out the Symptoms Check List – Revised (SCL-90-R) instrument to investigate the presence of symptoms of psychopathology. Patients with myofascial pain, alone or combined with TMJ pain, endorsed the highest scores in all SCL-90-R scales and showed the highest percentage of abnormal values in the depression (DEP) and somatization (SOM) scales for the assessment of depressive and somatization symptoms. Nonetheless, anova revealed no significant differences between groups in any of the SCL-90-R scales, except than in the Positive Symptom Total Index ( F  = 3·463; P  = 0·035), and the chi-squared test did not detect any significant differences between groups for the prevalence of abnormal scores in the DEP and SOM scales. The existence of a close association between pain and psychosocial disorders in TMD patients was supported by the present study. The null hypothesis is that no differences exist between patients with different painful TMD cannot be fully accepted for the presence of psychosocial disorders because of the trend evidencing higher SCL-90-R scores for myofascial pain patients, alone or combined with TMJ pain, with respect to TMJ pain alone.     

Multiple pains and psychosocial functioning/psychologic distress in TMD patients

PURPOSE: This study assessed multiple pain conditions and their association with psychosocial functioning, psychologic distress, and somatization in patients with temporomandibular disorders (TMD) based on RDC/TMD Axis II findings. Nonspecific pain items examined included headaches, heart/chest pain, lower back pain, nausea/abdominal pain, and muscle pain. MATERIALS AND METHODS: In this study, 202 TMD patients (58 men and 144 women) referred to two TMD clinics participated. The mean age of the predominantly Chinese patient population (82%) was 32.6 years (range 13 to 65). The RDC/TMD history questionnaire was input directly into computers by patients. Graded chronic pain and SCL-90 scales were generated online and automatically archived for statistical analysis. Data were subjected to Spearman's rank-order correlation and Kruskal-Wallis and Mann-Whitney tests at a significance level of .05. RESULTS: Of the patients, 43% were moderately to extremely distressed by headaches. The percentage of patients who were distressed by heart/chest pain (7%), lower back pain (26%), nausea/abdominal pain (17%) and soreness of muscles (22%) was lower. Of the TMD patients, 16% experienced more than three pain items. Significant and positive correlations were observed between number of pain items experienced and graded chronic pain severity, depression, and somatization. Correlation coefficients ranged from .27 to .65 for graded chronic pain scales and somatization (without pain items) scores, respectively. CONCLUSION: Results suggest that the number of nonspecific pain conditions reported may be a predictor of psychosocial dysfunction, depression, and somatization.     

Relationships between depression/somatization and self-reports of pain and disability

AIMS: To examine the relationship between depression and somatization and pain during muscle and joint palpation as well as limitations related to mandibular functioning (LRMF) in patients with temporomandibular disorders. METHODS: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) data for Axes I and II for 196 consecutive patients (56 men and 140 women) with a history of facial pain were obtained. The mean age of the predominantly Chinese patient population (83.2%) was 33.4 years (range 18 to 55 years). A computerized diagnostic system was used to collect the RDC/TMD history data. The Symptom Check List (SCL-90) depression and somatization scales were generated on-line and archived. The mean muscle pain (MP), joint pain (JP), and LRMF scores were computed with depression and somatization as main effects. Data were subjected to analysis of variance (Scheffé test) and Pearson's correlation at a significance level of .05. RESULTS: Depression scores ranged from 4.03 to 8.16 (MP), from 0.67 to 1.03 (JP), and from 0.30 to 0.38 (LRMF); somatization scores ranged from 2.64 to 7.75 (MP), from 0.58 to 1.00 (JP), and from 0.30 to 0.41 (LRMF). Interaction effects between depression and somatization were not significant. Patients with severe depression had significantly higher MP scores than normal patients or patients with moderate depression. Patients with moderate and severe somatization had significantly higher MP scores than normal patients. LRMF scores of patients with severe somatization were significantly greater than those who were normal or suffered from moderate somatization. No significant difference in JP scores was observed for depression and somatization scales. Correlations between depression/somatization and MP, JP, and LRMF scores were significant and positive but weak; coefficients ranged from 0.15 to 0.41. CONCLUSION: The results suggest that depression and somatization are related to the self-report of MP. In addition, severe somatization may be associated with an increase in jaw disability.     

Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study

Objectives

The relationship between the rate of chronic pain-related disability and depression and somatization levels as well as the influence of pain duration on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II findings were assessed in a three centre investigation.

Methods

The study sample (N = 1149; F:M 4.1:1, m.a. 38.6 years) consisted of patients seeking for TMD treatment and undergoing RDC/TMD axis II psychosocial assessment to be rated in chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression (Symptoms Checklist-90[SCL-90] scale for depression, DEP) and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM). The null hypotheses to be tested were that (1) no correlation existed between GCPS categories and DEP and SOM scores, and (2) no differences emerged between patients with pain from more or less than 6 months as for the prevalence of the different degrees of pain-related impairment, depression, and somatization.

Results

In the overall sample, the prevalence of high pain-related disability (GCPS grades III or IV), severe depression and somatization was 16.9%, 21.4%, and 28.5%, respectively. A correlation was shown between GCPS and both DEP and SOM categories (Spearman's correlation test, p < 0.001). A significant association between pain lasting from more than 6 months and high GCPS scores was shown (χ², p < 0.001), while no association was found between DEP and SOM scores and pain duration in the overall sample (χ², p = 0.742 and p = 0.364, respectively).

Conclusions

Pain-related disability was found to be strongly related with depression and somatization levels as well as associated with pain duration. Depression and somatization scores were not associated with pain duration.     

The role of psychological factors in the development of burning mouth syndrome

The psychiatric profiles of 50 patients diagnosed with burning mouth syndrome (BMS) were compared to those of 50 age- and sex-matched individuals as the control group. The Symptom Checklist-90-Revised (SCL-90-R) questionnaire was used to evaluate the role of psychological factors in the development of BMS. Somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety, psychoticism, global severity index (GSI), positive symptom total (PST), and positive symptom distress index (PSDI) scores were significantly higher in the patients with BMS than in the control group. In a subgroup analysis according to sex, women with BMS had higher T-scores for somatization, obsessive-compulsive, paranoid ideation, GSI, PST, and PSDI than women in the control group. In contrast, only the PSDI score was significantly higher in men with BMS compared to men in the control group. There was a significant difference in the T-scores for somatization, psychoticism, and GSI between the three age subgroups (≤50, 51–65, and ≥66 years). The obsessive-compulsive and PSDI scores were significantly higher in patients with BMS who also had at least one chronic disease than in patients with BMS who had no chronic disease. In conclusion, psychological factors are correlated with BMS.     

艾森克人格因素对颌骨囊肿开窗减压术后应用塞制器患者牙科焦虑症和疼痛的影响研究

目的:了解牙科焦虑症在颌骨囊肿开窗减压术后应用囊肿塞制器患者中发生情况,探讨艾森克人格因素对该类患者牙科焦虑症和疼痛的影响。方法:选择2015年1月~2016年10月于我院修复科就诊的该类成人患者126例,请患者于诊疗前填写改良牙科焦虑量表、艾森克人格问卷、视觉模拟量表,用SPSS 22.0进行统计分析。结果:颌骨囊肿开窗减压术后应用囊肿塞制器患者的牙科焦虑症患病率为60.32%。其MDAS得分与艾森克人格P(精神质)(r=0.241)、 N(神经质)(r=0.315)呈正相关,与E(内外倾)呈负相关(r=-0.322)。DA组P、N量表得分高于非DA组(P=0.000),E量表得分低于非DA组(P=0.000)。VAS得分与P(r=0.386)、N(r=0.329)呈正相关,与E(r=-0.237)呈负相关。DA组的VAS得分高于非DA组(P=0.009)。MDAS得分与VAS评分呈正相关(r=0.234)。结论:颌骨囊肿开窗减压术后应用塞制器患者牙科焦虑症及其术后疼痛评分与艾森克人格具有相关性,精神质、神经质高分和内外倾低分者患牙科焦虑症可能性大,疼痛程度较高。     

Psychologic status in patients with temporomandibular disorders

PURPOSE: The aim of this study was to investigate diferrences in the prevalence of depression and somatization scores in temporomandibular disorder (TMD) patients. MATERIALS AND METHODS: One hundred fifty-four patients with single and/or multiple RDC/TMD diagnoses were classified into 7 groups based on Axis I criteria. Somatization and depression scores from the Symptom Checklist-90 were compared between groups. RESULTS: The results of this investigation indicate that patients with myofascial pain and arthralgia psychologically differed from those with disc displacement. These results were in accordance with findings that support the notion that the pain induces psychologic sequelae, at least in relation to depression and somatization. CONCLUSION: It was concluded that psychologic factors play an important role in etiopathogenesis of TMD, as demonstrated by an increase in levels of depression and somatization in TMD patients.