Wilson曲线与颞下颌关节紊乱病的相关性研究进展

颞下颌关节紊乱病(TMD)的病因目前尚未完全阐明,病因主要来自牙合因素、社会心理因素、解剖因素、免疫因素以及关节负荷过重等多个方面。牙合因素作为颞下颌关节紊乱病中的影响因素,在颞下颌关节紊乱病的发生及发展过程中起到了推动性的作用。牙合曲线作为牙合因素中代表因素的一种,在TMD的发病机理中占有重要的地位。牙合、颞下颌关节与咀嚼肌共同构成口颌咀嚼系统的核心,三者相互联系,互相影响。     

成纤维细胞生长因子-2在颞下颌关节紊乱病中的作用

颞下颌关节紊乱病包括咀嚼肌紊乱疾病、结构紊乱疾病、炎性疾病和骨关节病。随着疾病的发展,往往会发生关节的退行性变。成纤维细胞生长因子-2具有广泛的生物活性,在关节疾病的发生、发展、转归中有一定作用,可能成为治疗颞下颌关节紊乱病的一个新靶点。     

成纤维细胞生长因子-2在颞下颌关节紊乱病中的作用

颞下颌关节紊乱病包括咀嚼肌紊乱疾病、结构紊乱疾病、炎性疾病和骨关节病。随着疾病的发展，往往会发生关节的退行性变。成纤维细胞生长因子-2具有广泛的生物活性，在关节疾病的发生、发展、转归中有一定作用，可能成为治疗颞下颌关节紊乱病的一个新靶点。     

1835名军事飞行人员颞下颌关节紊乱病的流行病学调查

目的：研究颞下颌关节紊乱病在我军飞行人员中的患病情况,探讨我军飞行人员颞下颌关节紊乱病的发病因素.方法：对1835名飞行人员进行口腔检查和颞下颌关节检查,筛选出颞下颌关节紊乱病患者,评估飞行人员颞下颌关节紊乱病与年龄、飞行时间、机种、咬合关系、不良习惯之间的关系.结果：歼击机飞行人员颞下颌关节紊乱病发病率最高（33.43％）,运输机飞行人员发病率最低（23.45％）,P＜0.05;颞下颌关节紊乱病发病率与飞行人员年龄、飞行时间无显著关系;心理因素、睡眠质量、夜磨牙、偏侧咀嚼习惯、第三磨牙伸长与飞行人员颞下颌关节紊乱病发病高度相关.错骀畸形是飞行人员TMD的重要发病因素,其中锁滁、开赡患者TMD发病率较高,其次是深覆盖、深覆骀及反骀患者.结论：飞行人员颞下颌关节紊乱病发病的重要因素是心理素质差、睡眠障碍、夜磨牙、偏侧咀嚼习惯及错（牙合）畸形.     

新疆医科大学大学生颞下颌关节紊乱病相关因素分析

目的: 调查新疆医科大学学生颞下颌关节紊乱病发病情况,分析疾病的相关因素。方法: 抽取新疆医科大学学生700名,其中男244名,女456名,平均年龄（20.08±1.457）岁,对其进行颞下颌关节检查、问卷调查（颞下颌关节相关病史,SCL-90自评量表）,计算患病率,采用SPSS17.0软件包对数据进行处理,并对相关因素进行逻辑回归分析。结果: 颞下颌关节紊乱病的患病率为42.40%,族别患病率差异无显著性。病史分析中,偏侧咀嚼习惯、夜磨牙习惯、口腔正畸治疗史、拔牙治疗史、心理因素均为危险因素。咬合因素中,前牙深覆、后牙正锁、个别牙扭转为危险因素。结论: 口腔不良习惯、心理因素、错畸形与颞下颌关节紊乱病的发生有关。     

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。     

上颌咬合板治疗颞下颌关节紊乱病

目的为寻找治疗颞下颌关节紊乱病的有效方法。方法对34例颞下颌关节紊乱病伴前牙深覆患者给予上颌板治疗。结果上颌咬合板对颞下颌关节疼痛、弹响以及张口受限等临床症状有明显的缓解作用。结论上颌咬合板可作为治疗颞下颌关节紊乱病的方法之一。     

IL-1在颞下颌关节紊乱病发病机制中作用的研究进展

颞下颌关节紊乱病是一种多因素疾病，关于颞下颌关节紊乱病的机制迄今仍未完全明了，因而其治疗也没有取得突破性进展。近年来，对颞下颌关节紊乱病病因机制的研究已集中在神经免疫学尤其是各种促炎细胞因子的解释．而白介素-1是颞下颌关节紊乱病病因和发展中最主要的致炎细胞因子．     

颞下颌关节疾病的外科治疗

颞下颌关节疾病(temporomandibular joint disease,TMD)包括颞下颌关节紊乱病、颞下颌关节损伤、颞下颌关节脱位、颞下颌关节强直、先天性或后天性畸形、炎性疾病以及肿瘤等,治疗方法有保守治疗和外科治疗。基础研究有助于了解颞下颌关节疾病的致病机理,并为颞下颌关节疾病的治疗提供理论依据。虽然颞下颌关节疾病的治疗多年来存在争议,但随着对颞下颌关节疾病了解的加深,以及影像学的发展、关节镜和手术方法的改进,颞下颌关节疾病的外科治疗有了明显进步。本文对颞下颌关节紊乱病、颞下颌关节脱位、髁突骨折、颞下颌关节强直、先天性或后天性畸形以及肿瘤等颞下颌关节疾病的外科治疗现况及进展进行了阐述。     

正畸治疗与颞下颌关节紊乱病关系的研究进展

颞下颌关节紊乱病是口腔临床常见病之一.一般认为颢下颌关节紊乱病是由多因素导致的咀嚼肌功能紊乱、颞下颌关节异常和退行性改变.近几十年来,正畸治疗与颢下颌关节紊乱病之间可能存在的关系一直是正畸医生研究和关注的焦点.本文就两者之间关系的研究作一.     

儿茶酚氧位甲基转移酶与颞下颌关节紊乱病疼痛关联性研究进展

颞下颌关节紊乱病（TMD）是口腔科难治性疾病之一,严重影响患者的生活质量和身心健康,由于其危险因素众多,目前发病机制尚未完全阐明。近年来精神心理因素备受关注,其对TMD发生的影响机制也十分复杂。儿茶酚氧位甲基转移酶（COMT）是一个与疼痛相关的基因,研究发现其在心理应激前后咀嚼肌组织中的表达发生变化,提示TMD患者的精神心理状态和COMT基因多态性存在相关性。本文就COMT基因与TMD的发生及调节之间的相关关系等方面做一综述。     

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??Temporomandibular joint disorders??TMD??are one of the most common and refractory diseases??and significantly influence living quality and physical and psychological health. The risk factors of TMD are more complex??and at present the pathogenesis has not been fully elucidated. In recent years??more people are concerned about the effect of psychological factors??but the effect and mechanism are complex. In foreign literature research of catechol-O-methyltransferase??COMT??as a gene associated with pain shows that before and after stress the COMT gene expression changes in masticatory muscle tissue of patients with TMD??so it can be concluded that there are correlation between the psychological state and COMT gene polymorphism. This article focuses on the effect and adjustment mechanism of COMT gene in TMD.     

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目的    探讨颞下颌关节紊乱病（TMD）发病情况及相关致病因素分析。方法    于2009年4—10月选择内蒙古自治区牧区蒙古族人群817人和城市汉族居民1006人为调查对象,利用颞下颌关节（TMJ）功能问卷和TMD临床检查相结合的方法进行流行病学研究。调查问卷包括受调查者身体状况、TMJ既往功能状况以及精神因素;临床检查包括下颌边缘运动、关节功能、咀嚼肌疼痛及牙齿缺失、修复情况。结果    蒙古族人群的TMD发病率远低于汉族人群（P < 0.05）;临床检查发现蒙古族人群和汉族人群在最大开口度,前伸、侧方最大运动距离差异无统计学意义（P > 0.05）。在TMD的可能致病因素中,蒙古族人群咬合力大于汉族人群（P < 0.05）。在牙齿缺失及修复方面蒙古族人群的后牙缺失后修复率明显低于汉族人群（P < 0.05）;蒙古族人群的肘、膝关节的疼痛发生率高于汉族人群（P < 0.05）。蒙古族人群存在心理问题明显低于汉族人群（P < 0.05）。结论    心理因素对于TMD的发生有决定性作用。     

Influence of psychological factors on risk of temporomandibular disorders

Psychological characteristics potentially may be a cause or consequence of temporomandibular disorder (TMD). We hypothesized that psychological characteristics associated with pain sensitivity would influence risk of first-onset TMD, but the effect could be attributed to variation in the gene encoding catechol-O-methyltransferase (COMT). We undertook a prospective cohort study of healthy female volunteers aged 18-34 yrs. At baseline, participants were genotyped, they completed psychological questionnaires, and underwent quantitative sensory testing to determine pain sensitivity. We followed 171 participants for up to three years, and 8.8% of them were diagnosed with first-onset TMD. Depression, perceived stress, and mood were associated with pain sensitivity and were predictive of 2- to 3-fold increases in risk of TMD (P < 0.05). However, the magnitude of increased TMD risk due to psychological factors remained unchanged after adjustment for the COMT haplotype. Psychological factors linked to pain sensitivity influenced TMD risk independently of the effects of the COMT haplotype on TMD risk.     

TMD Treatment Outcomes: A Statistical Assessment of the Effects of Psychological Variables

This study analyzes the degree to which pretreatment psychosocial factors (psychological dysfunctions and stress)effect outcome in 269 consecutive temporomandibular disorder (TMD) patients at the completion of treatment. Employing the TMJ Scale, a validated measure of TMD symptoms, it is found that pretreatment TMD pain and overall symptom levels (excluding internal derangement symptoms) are weakly but nevertheless, significantly related to pretreatment psychological dysfunction and stress. However, the latter appeared totally unrelated to four treatment outcome measures. Additionally, the data supports the hypothesis that both initial and post-treatment intrascapular symptoms (TMJ Scale, Joint Dysfunction sub-scale) are unrelated to psychosocial factors. Data from this study call into question the value of categorizing the TMD patients by means of psychosocial “profiling” and “dual-axis” classification methods proposed by some researchers.     

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。     

Reduced heart rate variability and increased saliva cortisol in patients with TMD

Temporomandibular disorders (TMD) are the most common source of non-dental pain. The pathogenesis of TMD is multifactorial, involving biological, psychological and behavioral factors. Those factors are involved with alterations of the autonomic nervous system (ANS) and stressful conditions. Heart rate variability (HRV) has been used as a marker of ANS function. Increased cortisol level (a stress indicator), has been found in chronic pain. Therefore, the present study aimed to compare pain intensity, HRV, psychological factors, and salivary cortisol level between TMD patients and a control group. Twenty-one TMD patients and twenty-three healthy control subjects participated in the study. All participants underwent 24-h-Holter monitoring to record HRV. Morning unstimulated saliva samples were collected from each participant for cortisol analysis. The pain intensity was assessed using a visual analog scale. The participants were evaluated for anxiety and depression via the Hospital Anxiety and Depression Scales. We found that pain intensity and psychological distress in the TMD group were significantly greater than those of the control (p < 0.01). Pain intensity showed a positive correlation with psychological distress (p < 0.01). HRV parameters in the TMD group were significantly lower than those in the control, suggesting reduced HRV in TMD patients. Pain intensity was negatively associated with HRV. Salivary cortisol level of the TMD group was greater than that of control. Our findings indicate that reduced HRV with higher psychological distress and increased salivary cortisol levels were observed in the TMD group. Therefore, TMD patients may benefit from interventions that can restore ANS function and stress balance.     

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.     

Psychological factors related to temporomandibular disorders: an evaluation of students preparing for college entrance examinations

The aim of this study was to research how stress and anxiety affected the development of temporomandibular disorders (TMD) in 55 high school graduates at two different times: six months before and one the week before their college entrance examinations. The American Academy of Orofacial Pain (AAOP) Questionnaire, Lipp's Stress for Adults Inventory (ISSL) and the Beck Anxiety Inventory (BAI) were used to evaluate TMD, stress and anxiety, respectively. The data were submitted to Pearson's and Spearman's correlation tests. At first the results showed higher positive correlation between anxiety and TMD than between stress and TMD. Out of the total participants, 36% had TMD, and of these, only 12.7% had no psychological disorder. One week before the tests there were high positive correlations between TMD and the psychological factors studied, and 50.9% of the students had TMD, of which only 9% had no psychological disorder The most prevalent signs of TMD symptomatology were joint sounds and headache, followed by neck pain. It was concluded that students preparing to take college entrance examinations are a potential risk group for developing TMD due to psychological factors generating anxiety and stress. Anxiety becomes more significant as the semester progresses, and both anxiety and stress increase as the examination dates approach.