弱激光治疗颞下颌关节紊乱病疼痛的研究进展

疼痛是颞下颌关节紊乱病患者最常见的临床表现之一,也是大多数人治疗颞下颌关节紊乱病的原因。弱激光在牙科领域的应用越来越广泛,且在颞下颌关节紊乱病治疗中的应用也越来越多,用来抗炎和缓解疼痛。本文对弱激光疗法在治疗颞下颌关节紊乱病疼痛机理方面进行概述。了解弱激光疗法的机制对弱激光治疗颞下颌关节紊乱病具有重要意义。     

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。     

颞下颌关节紊乱病与系统性疾病相关性研究进展

颞下颌关节紊乱病是口腔颌面部常见的疾病之一,颞下颌关节紊乱病并非指单一疾病,它是一类病因尚未完全清楚而又有相同或相似临床症状的一组疾病的总称。颞下颌关节紊乱病的发病机制尚未完全阐明,多数学者解释为多种致病因素相互作用下发生。近年来研究发现糖尿病、类风湿性关节炎、系统性红斑狼疮、强直性脊柱炎等全身系统性疾病与颞下颌关节紊乱病的发生相关,本文对颞下颌关节紊乱病与部分系统性疾病相关性研究进展进行阐述。     

磨牙症与颞下颌关节紊乱病关系的研究

磨牙症和颞下颌关节紊乱病都是口腔临床上的常见病，均病因不明，诊治困难。多年来学者们试图研究两者的内在联系和机制，但至今观点仍不统一。本文就磨牙症与颞下颌关节紊乱病的关系以及磨牙症引起颞下颌关节紊乱病的可能机制的研究进展作一综述。     

关节源性颞下颌关节痛患者关节内窥镜检查结果

目的　探讨颞下颌关节紊乱病伴关节源性关节痛患者的关节腔内状况。方法　对20例颞下颌关节紊乱 病伴关节源性关节痛患者(按Truelove等关于颞下颌关节紊乱病的诊断分类标准确定)的23侧颞下颌关节先后进 行X线片检查和关节内窥镜检查。结果　关节镜下23侧关节内至少存在1种不同程度的腔内病变,最多有6种病 变共存。结论　局限于颞下颌关节的关节痛可能与关节腔内病理改变有关,可能是炎症(滑膜炎)引起疼痛。     

雌激素与颞下颌关节紊乱病

颞下颌关节紊乱病的流行病学调查发现女性患病率高于男性,且存在年龄分布,使得雌激素在其发病机制中的作用引起学者的注意。雌激素能够影响颞下颌关节组织结构如骨、软骨、关节盘等多种组织的生长、代谢、改建重建等,并能影响疼痛的调节机制,从而可能在颞下颌关节紊乱病的病理生理过程中起作用。     

颞下颌关节间接性损伤后转归及其机理

颌面部损伤常问接造成颞下颌关节损伤,如不及时治疗,可引起颞下颌关节内紊乱(TMJID)、颞下颌关节骨关节病(TMJOA)及颞下颌关节纤维性或骨性强直等后遗症的发生。本文就间接性TMJ损 伤后的转归,及导致并发症的机理,TMJ损伤与TMJID和TMJOA之间的关系做一系统综述。     

颞下颌关节紊乱病疼痛的精神心理因素

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。近年研究发现颞下颌关节的疼痛症状与精神心理因素密切相关。本文对二者的联系作一简要综述。     

颞下颌关节紊乱病实验动物模型的研究进展

颞下颌关节紊乱病是口腔颌面部常见病，由于其发病隐匿，加之颞下颌关节的特殊解剖关系，使临床研究比较困难，因此建立实验动物模型研究其发病机制及治疗手段十分必要。本文则就颞下颌关节紊乱病实验动物模型的选择，建立方法及其在病理、免疫、生化、生物力学等方面的研究进展作一综述。     

以按摩为主的综合治疗颞下颌关节紊乱病800例的体会

根据颞下颌关节紊乱病的发病机制,针对功能性肌紧张的咀嚼肌施行分离肌粘连、理顺紧张的肌纤维、痛点及关节区按摩加热敷、心理疏导等方法综合治疗颞下颌关节紊乱病。通过对临床800例患者近20年的观察,结果表明针对早期、病程较短、不伴有关节弹响而病因较明确的颞颌下关节紊乱病的患者采用本法治疗有较显著的疗效,其方法简便易行。     

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。     

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.     

Common factors in the presentation and management of chronic temporomandibular disorders and chronic overlapping pain disorders

The International Association for the Study of Pain has released a new classification scheme for chronic pain. This classification scheme describes chronic pain as either a symptom of a disease (chronic secondary pain) or the disease itself (chronic primary pain). Chronic temporomandibular disorders have many similarities to other proposed chronic overlapping pain disorders, but are classified and managed by dental practitioners as a localized pain condition of the orofacial region. We review the literature to describe the similarities between chronic temporomandibular disorders and chronic overlapping pain disorders, and discuss how this evolving concept may affect the way that dentists approach the diagnosis and management of chronic temporomandibular disorders.     

Pathophysiology of TMD pain – basic mechanisms and their implications for pharmacotherapy

Summary This article discusses the pathophysiology of temporomandibular disorders (TMD)‐related pain and its treatment with analgesic drugs. Temporomandibular disorders are comprised of a group of conditions that result in temporomandibular joint pain (arthralgia, arthritis) and/or masticatory muscle pain (myofascial TMD). In at least some patients with TMD, a peripheral mechanism contributes to this pain. However, there is often a poor correlation between the severity of TMD‐related pain complaints and evidence of definitive tissue pathology. This has led to the concept that pain in some patients with TMD may result from altered central nervous system pain processing and further that this altered pain processing may be attributable to specific genes that are heritable. Psychosocial stressors are also thought to contribute to the development of TMD‐related pain, particularly masticatory muscle pain. Finally, substantially more women suffer from TMD than men. Although there are arguably multiple reasons for sex‐related differences in the prevalence of TMD, one candidate for the increased occurrence of this disorder in women has been suggested to be the female sex hormone oestrogen. Analgesic drugs are an integral part of the primary treatment for TMD‐related pain and dysfunction with more that 90% of treatment recommendations involving use of medications. The most commonly used agents include non‐steroidal anti‐inflammatory drugs, corticosteroids, muscle relaxants, anxiolytics, opiates and tricyclic antidepressants, however, evidence in support of the effectiveness of these drugs is lacking. Continued research into the pathophysiology of TMD‐related pain and the effectiveness of analgesic treatments for this pain is required.     

Depression levels in chronic orofacial pain patients: a pilot study

The assessment of depressive behaviour in chronic pain patients is especially important, because depression is commonly associated with chronic pain. The aim of this pilot study was to compare depression levels between patients with head and neck cancer pain and temporomandibular disorders (TMD), and to determine whether there is an association between depression levels and chronic pain severity. This study was an observational and sectional study and the sample consisted of 40 patients, uniformly divided into those with chronic orofacial pain related to cancer and those with painful TMD classified with research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I. Depression levels, pain intensity and severity were assessed with RDC/TMD axis II. The study demonstrated statistically significant differences in depression levels present in the head and neck cancer pain group and the painful TMD group, with the occurrence of a moderate statistically significant correlation between depression levels and chronic pain severity.     

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。     

Reduction in parafunctional activity: a potential mechanism for the effectiveness of splint therapy

Interocclusal splints may be an effective modality in the management of temporomandibular disorders (TMD), but there is little evidence regarding the mechanism by which splints work. This study tested the hypothesis that pain reduction produced by splints is associated with reduction in parafunctional activity. In a two-group, single-blinded randomized clinical trial, patients diagnosed with myofascial pain received full coverage hard maxillary stabilization splints. Patients were instructed to maintain or avoid contact with the splint for the 6 weeks of active treatment. Patients who decreased the intensity of tooth contact were expected to show the greatest alleviation of pain, and those who maintained or increased contact were expected to report lesser reductions in pain. Experience-sampling methodology was used to collect data on pain and parafunctional behaviours at pre-treatment and during the final week of treatment. Patients were reminded approximately every 2 h by pagers to maintain/avoid contact with the splint. The amount of change in intensity of tooth contact accounted for a significant proportion of the variance in pain change scores. Patients who reduced tooth contact intensity the most reported greater relief from pain. Splints may produce therapeutic effects by reducing parafunctional activities associated with TMD pain.