心理因素与颞下颌关节紊乱病症状表现的相关性研究

目的:探讨焦虑和抑郁是否为罹患颞下颌关节紊乱病(TMD)的危险因素。方法:病例组为临床TMD患者,对照组为无TMD症状的健康人,采用焦虑症状自评量表(SAS)和抑郁症状自评量表(SDS)对心理因素进行评估。同时记录是否存在其他混杂因素,如习惯咬硬物、偏侧咀嚼、叩齿、夜磨牙、拔牙史等。采用Stata 11.0软件包对数据进行统计学分析。结果:共纳入200例样本,每组各100例,病例组SAS评分、SDS评分均显著高于对照组(P<0.05)。对不同严重程度焦虑倾向、抑郁倾向的OR进行趋势检验,均具有统计学意义。但logistic回归分析显示,患颞下颌关节紊乱病的危险因素中,仅焦虑倾向与偏侧咀嚼具有统计学意义(P<0.05)。结论:焦虑倾向与抑郁倾向为TMD相关的重要危险因素,随着其严重程度的增加,患TMD的危险性也增加。在混杂因素偏侧咀嚼存在时,只有焦虑倾向仍然是TMD的危险因素。     

颞下颌关节紊乱病患者的三维咬合接触观察

目的 :探讨颞下颌关节紊乱病 (TMD)患者的咬合异常特征。方法 :2 3名无症状全牙列大学生志愿者和 10 1名全牙列TMD患者 ,取研究模 ,从垂直向、颊舌向、近远中向三维方向观察、记录并以指数评价咬合特征 ;TMD患者摄许勒片及侧位体层片 ,弹响关节摄造影片 ,分析咬合指数与颞下颌关节 (TMJ)影像变化的关系。结果 :66.3 %的TMD患者有垂直向咬合异常 ,其垂直向咬合指数明显高于对照组 (P <0 .0 5 ) ;垂直向咬合异常与TMJ影像结果间未见明显相关性 (P >0 .0 5 )。结论 :垂直向咬合异常与TMD临床表现有密切关系。     

Activator矫治对颞下颌关节的影响及其与颞下颌关节紊乱病的关系

Activator矫治器是较早用于临床的功能矫治器,由Andresen于1908年设计,对安氏Ⅱ类1分类错(牙合)畸形患者有良好的治疗效果,通过前移下颌刺激下颌骨的生长且抑制上颌矢状向生长,从而调节上下颌骨矢状向的关系.目前,关于Activator矫治器的矫治原理还存在较多的分歧,其中之一就有Activator是否能刺...     

润滑功能与颞下颌关节紊乱病

颞下颌关节是具有复杂运动的联动关节，其长期的健康状态与润滑功能密不可分。其有关的润滑机理包括滑液、关节盘和关节软骨等方面。关节内自由基过多可以导致润滑功能障碍，颞下颌关节紊乱病与润滑功能障碍密切相关。     

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。     

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.     

颞下颌关节紊乱病的治疗

关于因素是否颢下颌关节紊乱病(TMD)病因之一,以及TMD的治疗,现存在着各种争议.本文回顾了有关研究及观点.目前,无论是动物实验研究,还是临床实验研究,都不足以作出因素是TMD病因之一的结论.但是, 治疗在TMD临床治疗中占有重要地位,且发挥重要作用:调能有效地缓解慢性头痛,颈痛及肩部痛; 治疗对减轻TMD患者的肌肉疼痛也显示理想效果;调位咬合板能消除一部分关节弹响.进一步探索TMD的因素,正确掌握TMD 治疗的适应证及客观科学地评价治疗的临床效果是我们今后研究的课题.     

咀嚼运动轨迹与颞下颌关节紊乱病患者症状和咬合异常的关系

目的：探讨颞下颌关节紊乱病（TMD）患者的下颌咀嚼运动轨迹特点,及其与症状和咬合异常的关系。方法：23名无症状大学生志愿者和130名TMD患者,取研究模,记录咀嚼运动[牙合]期轨迹。结果：无症状对照组和TMD组咀嚼运动[牙合]期轨迹的形态没有显著差异（P〉0．05）。TMD组矢状面咀嚼运动轨迹的ICP稳定比例明显低于对照组（P〈0．01）,但冠状面上咀嚼运动轨迹的ICP稳定比例两组间无明显差异（P〉0．05）。TMD组矢状面[牙合]期轨迹分型与近远中向咬合关系的3级计分存在明显相关关系（P〈0．01）,近远中向咬合关系不正常者出现不重合型轨迹的比例较高。疼痛和关节弹响症状与咀嚼运动[牙合]期轨迹形态无关。结论：近远中向咬合关系对咀嚼运动有明显的引导作用。     

颞颌关节紊乱综合征的焦虑和抑郁因素调查

心理因素与颞颌关节紊乱综合征（ＴＭＪＤＳ）的关系在国外有较多报道,研究的焦点集中在人格、焦虑、抑郁、生活事件等几个方面。国内在这方面的研究尚少［１］。笔者在对大学生ＴＭＪＤＳ牙合和龋因素的调研［２］基础上,对ＴＭＪＤＳ的焦虑与抑郁状况进行初步研究,现...     

颞下颌关节紊乱病患者咬合稳定性的研究

目的研究颞下颌关节紊乱病(tempromandibular disorders,TMD)患者的咬合稳定状况。方法应用T-ScanII咬合分析仪对34例TMD患者进行牙尖交错位的咬合检查并与正常组对照。结果TMD患者的力不对称指数、力中心点最大位移、干扰指数均明显高于对照组,但总力值与对照组无显著性差异。结论与正常人群相比,TMD患者咬合的稳定性及平衡性均下降。     

成人颞下颌关节紊乱病与颈椎姿势的相关性研究

目的：探讨颞下颌关节紊乱病成人患者颈椎姿势与健康者的差异,研究颞下颌关节紊乱病与颈椎姿势的相关性。方法：对20例成人颞下颌关节紊乱病患者及20例成人健康者拍摄自然头位时的头颅定位侧位片,进行投影测量及统计学分析。结果：成人颞下颌关节紊乱病组的颈椎弯曲度大于健康对照组而颈椎倾斜度小于健康对照组,颈椎齿突切线、颈椎切线分别与前颅底平面及水平线交角减小,表明成人颞下颌关节紊乱病患者头呈前倾、前伸位。结论：头颈姿势位与颞下颌关节紊乱病存在明显相关性,颞下颌关节紊乱病患者头呈前倾、前伸位。     

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.     

Relationship between anxiety and temporomandibular disorders in dental students

Objective: To evaluate the prevalence of temporomandibular disorder (TMD) in dental students and its correlation with anxiety.

Methods: After probability sampling, 105 students were selected. The diagnosis of TMD was carried out using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) – Axis I; the anxiety level was obtained by the State-Trait Anxiety Inventory (STAI). Data from TMD and anxiety were calculated through frequency and Chi-square test to assess the association between TMD and anxiety, considering a significance level of 5%.

Results: TMD was present in 36.2% of the students; disc displacement (42.1%), and arthralgia (42.1%) were the most prevalent subtypes. The majority of students presented both traits (57.1%) and state (65.7%) anxiety in mild levels, followed by moderate levels. No statistical association between TMD and anxiety was found (p > 0.05).

Conclusion: Joint TMD was the most prevalent subtype of TMD in dental students and was not associated with anxiety levels.     

颌面恶性肿瘤患者术后抑郁焦虑状态干预策略的探讨

目的:了解颌面部肿瘤患者术后抑郁焦虑状态,并探讨相关的心理干预策略.方法:口腔颌面恶性肿瘤患者37例.术前利用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)测评其抑郁和焦虑状态,术后7 d再次进行的抑郁焦虑调查和相应心理干预.干预6周后再次进行抑郁和焦虑状态的评定,分析前后数据.结果:37例颌面肿瘤患者术后3 d的抑郁和焦虑状态比较严重,干预6周后,HAMD、和HAMA评分均明显减低.差异有显著性(P＜0.05).结论:颌面部肿瘤患者在手术后存在明显抑郁焦虑的状态,在关注患者身体状态恢复的同时也要关注他们的情绪状态.     

颞下颌关节紊乱患者心理因素与唾液中SIgA含量的关系

目的观察人格、应激、情绪与应对方式等心理因素在颞下颌关节紊乱病(TMD)中的作用及其与口腔局部免疫功能的关系。方法采用明尼苏达多相人格调查表(MMPI)、生活事件调查表、特质应对问卷、自我评定焦虑量表(SAS)、抑郁自评表(SDS)对确诊TMD患者31例和匹配对照组30例进行个别心理测试,以放射免疫法对两组被试唾液中的SIgA含量进行测定。结果TMD患者MMPI诸指标得分均高于对照组,差异有显著性(P<0.05,P<0.01),其中有10例患者的临床量表得分高于全国常模正常值;病人组的负性生活事件和负性工作得分均高于正常对照组,差异有显著性(P<0.05,P<0.01);病人组正性应对的得分低于正常对照组,而负性应对的得分高于正常对照组,差异有显著性(P≤0.05,P<0.01);病人组的焦虑、抑郁得分均高于正常对照组,差异有显著性(P<0.01);病人组唾液中SIgA含量低于正常对照组,差异有显著性(P<0.01);抑郁得分与SIgA含量呈轻度负相关(r=-0.320,P<0.05)。结论TMD患者具有明显的人格偏离、不良生活事件、不良情绪和负性应对方式,这些所导致的更强、更持久的应激以及口腔局部免疫功能的低下,是疾病的重要原因之一。     

Temporomandibular disorder symptoms and their association with quality of life,emotional states and sleep quality in South‐East Asian youths

Population studies on the prevalence of temporomandibular disorders (TMD) and their associations with quality of life (QoL), emotional states and sleep quality in South‐East Asian youths are not available. This cross‐sectional study assessed the presence of TMD and their relationships to QoL, depression, anxiety, stress and sleep quality in a cohort of South‐East Asian adolescents/young adults. Three hundred and sixty‐two students from a polytechnic were enrolled in the study and completed an online questionnaire consisting of the Fonesca's Anamnestic Index (FAI), Oral Health Impact Profile for TMD (OHIP‐TMD), Depression, Anxiety and Stress Scales‐21 (DASS‐21) and Pittsburgh Sleep Quality Index. The FAI appraises TMD severity while OHIP‐TMD determines the effect of TMD on oral health‐related QoL. Statistical analysis was performed using chi‐square test for categorical data whilst one‐way ANOVA/post hoc Bonferroni's tests were employed for numerical scores (P < 0.05). Of the 244 participants who completed the questionnaires in their entirety (37 males; 207 females, mean age 20.1 ± 3.2 years), 32.4% had mild TMD, 9.4% had moderate TMD and 58.2% were TMD free. The total prevalence of TMD was 41.8% (n = 102) and most OHIP‐TMD domains including functional limitation (P = 0.000), physical pain (P = 0.000), handicapped (P = 0.000) and psychological discomfort (P = 0.001) showed significant differences in mean scores depending on TMD severity. A similar trend was observed for DASS‐21. The majority of participants with TMD (69.6%; n = 71) had poor sleep quality (P = 0.004). TMD appear to be prevalent in South‐East Asian youths with varying severity. Severity of TMD had some bearing on QoL, emotional states as well as sleep quality.     

Depression and diffuse physical symptoms in southern Chinese with temporomandibular disorders

Summary  The study investigated the experience of depressive symptoms and the relationship with diffuse physical symptoms reporting in southern Chinese seeking professional care for temporomandibular disorders (TMD) in Hong Kong. Eighty-seven new patients [77 females/10 males; mean age 39·3 years (SD 12·7)] referred to the specialist TMD clinic at the Prince Philip Dental Hospital, Hong Kong participated in this study. The Research Diagnostic Criteria (RDC)/TMD history questionnaire was used to derive Axis II psychological data. Psychological status was assessed through depression and non-specific physical symptoms (NPS) scores (pain items included and excluded) measured with RDC/TMD Axis II instruments; 42·5% of patients experienced moderate/severe depression symptoms; 59·8% and 57·5% had moderate/severe NPS scores when pain items were included and excluded, respectively. Strong, positive and statistically significant correlations were noted between depression scores and the NPS scores that included pain items ( r  = 0·80) and those that did not ( r  = 0·80). The correlations remained consistent and were of similar magnitude when male patients were excluded from the computation and also when the possible effect of patient age was controlled. While taking into account the modest patient sample which was related to a low rate of treatment seeking, depressive symptoms were common and similar to other western and Chinese patient groups. NPS reports were higher than in Singapore Chinese patients. There appeared to be a clear association between depression and diffuse physical symptoms. The findings should be considered in the holistic care of Chinese people with TMD.