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.     

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。     

伴TMD的成人正畸患者心理健康状况调查与分析

目的:探讨伴颞下颌关节紊乱病(TMD)的成人正畸患者的心理健康状况。方法:应用90项症状清单(Self-reportingInventory,SCL-90)对42例伴TMD的成人正畸患者(实验组),50例无正畸需求的伴TMD的成人错人群(对照组)进行测试,结果进行t检验。结果:2组测试在强迫症状、抑郁、焦虑、偏执、人际关系敏感因素上得分高于全国成人常模(P<0.05)。实验组在强迫症状、抑郁、焦虑、人际关系敏感因素上得分与对照组有显著性差异(P<0.05)。结论:伴颞下颌关节紊乱病的成人正畸患者存在一定程度的心理问题。     

颞下颌关节紊乱病与下颌第一磨牙龋因素的流行病学研究

目的:探讨下颌第一磨牙龋损状况和颞下颌关节紊乱病(TMD)的关系和作用机制,为预防因下颌第一磨牙龋损而导致的TMD提供流行病学依据.方法:以西安市驻军某部入伍新兵为研究对象,采用下颌第一磨牙龋损、TMD临床诊断标准和安氏分类等方法,对896名17～20岁入伍新兵进行流行病学研究,分析下颌第一磨牙龋损状况和TMD发病之间的关系.结果:受测人群中下颌第一磨牙龋患率为55.3%.正常(牙合)TMD阳性率为8.6%,异常(牙合)TMD阳性率为37.1%,二者有显著性差异(P＜0.05);龋损组正常(牙合)和异常(牙合)受测者TMD阳性率明显增高(龋损组TMD阳性率分别为10.6%和49.5%,P＜0.05),正常(牙合)和异常(牙合)中下颌第一磨牙龋损波及功能面的受测者TMD阳性率远远高于未波及功能面受测者.结论:下颌第一磨牙龋损是引起异常(牙合)和TMD的重要原因之一,龋损波及功能面者更易导致TMD.     

颞下颌关节紊乱病在不同年龄群体的调查研究

目的:探讨不同年龄群体的颞下颌关节紊乱病(TMD)的患病情况,临床特点及其差异性。方法:采用随机整群抽样方法,抽取368名65～75岁广东籍老人和681名18～23岁广东籍大学生作为研究对象。应用非条件Logistic回归模型和χ2检验对调查结果进行分析。结果:在老人组,TMD体征阳性者239名(239/368,64.9%),表现为关节弹响和杂音46人次(46/368,12.5%),下颌运动异常58人次(58/368,15.8%),疼痛192人次(192/368,52.2%),人均临床症状1.2(296/239);在大学生组中,TMD体征阳性者286名(286/681,41.9%),表现为关节弹响和杂音102名(102/681,15%),下颌运动异常185名(185/681,27.2%),疼痛127名(127/681,18.5%),人均临床症状1.4(414/286)。老年人后牙缺失、偏侧咀嚼和牙合创伤是主要危险因素;而在大学生组,精神因素、错颌畸形/下颌第三磨牙阻生、偏侧咀嚼是这一年龄段人群TMD发生的主要危险因素。结论:广东籍老年人TMD的发病率高于大学生组,后牙缺失是老年人TMD发生的最主要致病因素;精神因素则是大学生群体TMD发病的首要致病因素。老年人首要临床症状是疼痛,而大学生则是弹响与杂音。     

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。     

单侧有多种症状的颞下颌关节紊乱患者双侧关节锥形束CT对比研究

目的:探讨单侧有多种症状的颞下颌关节紊乱(temporomandibular disorders,TMD)患者双侧颞下颌关节(temporomandibular joint,TMJ)在锥形束CT(cone-beam computed tomography,CBCT)成像上可能存在差异的参考层面,为TMD诊断和对比研究提供参考.方法:选取仅一侧TMJ有多种症状的TMD患者(不含仅有一种症状的病例)50例,通过CBCT三维成像和重建,观察比较同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS 13.0软件包对每例患者上述各测量指标进行两配对样本t检验.结果:两侧TMJ在矢状位60°关节间隙时的测量值差异显著(P＜0.05),平行位120°关节间隙、矢状位90°关节间隙时的测量值差异显著(P＜0.01),其余测量值均无显著差异.结论:对于单侧有多种症状的TMD患者,矢状位或垂直位是较易观察到两侧关节有差异的位置,在这一层面重建意义较大.     

528例儿童颞下颌关节紊乱病的回顾性研究

目的:探讨儿童TMD患者528例的性别、年龄对TMD症状体征的发生情况和CBCT表现的影响.方法:采用回顾性研究方法,收集6-14岁TMD患者,分别按照性别及年龄(6-8岁低年级、9-11岁中年级、12-14岁高年级)分组,对疼痛、弹响或杂音、开口型异常及开口受限等症状体征和CBCT影像学表现进行归纳分析.结果:男性1...     

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。...     

老年颞下颌关节紊乱病53例的临床分析

颞下颌关节紊乱病(TMD)是口腔科的一种常见病、多发病,其病因复杂,病程迁延,治疗棘手.近年来随着我国老年人口的急剧增加,对老年TMD的研究已成为一个重要的课题.现收集53例老年TMD患者,对其病因、症状、诊断和治疗等进行临床分析和总结.     

Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy

The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporomandibular disorder (TMD), and the effect of orofacial myofunctional therapy. The study was conducted on eight asymptomatic subjects (Group C) and 20 subjects with articular TMD, randomly distributed over two groups: one treated using orofacial myofunctional therapy (OMT Group) and a control group with TMD (Group CTMD). Patient selection was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). All subjects submitted to a clinical examination with self-reporting of symptom severity, and to orofacial myofunctional and electromyographic evaluation at diagnosis and again, at the end of the study. Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made (p < 0.05). In the diagnosis phase, subjects with TMD reported earache (65%), tinnitus (60%), ear fullness (90%), and 25% of the asymptomatic subjects reported tinnitus. The otologic symptoms were correlated with tenderness to palpation of the temporomandibular muscles and joints and with orofacial symptoms. Only the OMT group showed a reduction of otologic and orofacial symptoms, of tenderness to palpation and of the asymmetric index between muscles. OMT may help with muscle coordination and a remission of TMD symptoms.     

Is there an association between anxiety/depression and temporomandibular disorders in college students?

Objective

Considering the high incidence of Temporomandibular Disorders (TMD) in the population aged 15-30 years and the fact that students are exposed to stressful psychosocial factors, the purposes of this study were: to verify clinical symptoms and jaw functionality in college students with TMD according to the anxiety/depression (A/D) level and to evaluate the correlation between A/D and functionality, maximum mouth opening (MMO) and pain and muscle activity.

Material and Methods

Nineteen students with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent two assessments during an academic semester. The evaluations were based on questionnaires (MFIQ - Mandibular Function Impairment Questionnaire; HADS - Hospital Anxiety and Depression Scale), clinical measurements (MMO without pain, MMO and assisted MMO; palpation of joint and masticatory muscles), and electromyography. The HADS scores obtained in the two assessments were used to classify all data as either "high" or "low" A/D. Data normality, differences and correlations were tested with the Shapiro-Wilk test, Student''s t-test (or the Wilcoxon test), and Spearman test, respectively. The alpha level was set at 0.05.

Results

None of the clinical variables were significantly different when comparing low and high A/D data. In low A/D there was a significant correlation between HADS score and: MFIQ (P=0.005, r=0.61), and MMO without pain (P=0.01, r=-0.55).

Conclusions

Variation in A/D level did not change clinical symptoms or jaw functionality in college students with TMD. Apparently, there is a correlation between TMJ functionality and A/D level, which should be further investigated, taking into account the source of the TMD and including subjects with greater functional limitation.     

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目的探讨拔除阻生智牙治疗大学生颞下颌关节紊乱病（temporomandibular disorders,TMD）的临床效果。方法选择2009年9月以来广东工业大学医院口腔科青年大学生TMD并智牙阻生患者136例,随机分为2组,每组68例,试验组采取心理＋药物＋局部理疗＋阻生牙拔除术等综合治疗,对照组仅采取心理＋药物＋局部理疗等保守治疗。两组完成治疗后随访观察1年,对比疗效差异。结果试验组总有效率为91.2%,对照组总有效率78.0%,两组疗效差异有统计学意义（P〈0.05）。结论拔除阻生智牙对治疗青年大学生TMD有较好的疗效,可列为青年大学生TMD系列治疗方法之一。     

The orthodontic treatment of TMD patients: EMG effects of a functional appliance

The aim of this work was to test the effects of the Function Generator Bite (FGB) on the masticatory muscles of temporomandibular joint dysfunction (TMD) subjects. Two groups were selected for the study. A group of 20 TMD patients (group F) requiring orthodontic treatment and treated with FGB and a group of 10 healthy subjects (group H) were considered. Both groups were evaluated before the therapy began (TO) and then after 18 months of therapy (T1). An electromyographic analysis of the masseter and temporalis anterior muscles and a clinical evaluation according to the Research Diagnostic Criteria for TMD (RDC/TMD) were performed. A statistical difference between the two groups was observed at TO with respect to the activity index. TMD subjects showed a lower value of the index. Further studies are necessary to fully understand the utility of this EMG index as a diagnostic indicator.     

青少年spee曲线深度与颞下颌关节紊乱病的相关性研究

目的:研究青少年spee曲线深度与颞下颌关节紊乱病的相关性.方法:根据颞下颌关节紊乱病诊断标准将选取的在校大学生192人分为两组,测量spee曲线深度.将结果进行Spreaman检验和t检验,以P＜ 0.05为差异有统计学意义.结果:spee曲线深度在0-2mm时与TMD的发生率呈负相关性(r=-0.731,P＜ 0.05),在大于2mm时呈正相关(r=0.786,P＜0.05).TMD组左右两侧spee曲线深度差异有统计学意义P=0.01,对照组左右两侧spee曲线深度差异无统计学意义P=0.1 09,而TMD组与对照组之间spee曲线深度的均值差异无统计学意义P=0.062.结论:过大或过小的spee曲线均会导致TMD的患病风险增加,并且左右两侧的spee曲线深度差异过大也会诱使TMD的发生.     

Bite force, endurance and masseter muscle fatigue in healthy edentulous subjects and those with TMD

It is well known that bite force and EMG activity are considerably reduced in edentulous patients, but the susceptibility of their jaw-closing muscles to localized fatigue is less certain. This information is even less clear for edentulous subjects who have TMD. Eleven healthy edentulous subjects and 10 edentulous subjects with TMD participated in this study. Maximum bite force was measured first, with the transducer placed on the canine-first premolar region bilaterally, and then two rapid relaxations were made from a brief voluntary clench to 50% of maximum. A sustained voluntary clench of 50% of maximum was then maintained and endurance time was noted. EMG was recorded from both masseter muscles and the median frequency of the power spectrum of the EMG from 2 s at the beginning of the sustained clench and 2 s at the end was subsequently calculated. Two more rapid relaxations from brief clenches were performed immediately after the sustained clench. The mean maximum bite force in the healthy group was 115 N (SD +/-41) and in the TMD group was 75 N (SD +/-22), this difference being significant (P = 0.0013). The mean endurance time in the healthy group was 86 s (SD +/-51) and in the TMD group was 63 s (SD +/-20). The percentage change in the median frequency in the healthy group as a result of the sustained contraction was 6% (left) and 8.6% (right) and in the TMD group was 13.9% (left) and 12.8% (right). The percentage change in the mean relaxation half time for the healthy group was 28.5% and for the TMD group was 72%, a significant difference (P = 0.0046). It was apparent that the maximum bite force was low in edentulous subjects and was further reduced in edentulous TMD subjects; endurance time was reduced in TMD subjects; fatigue resistance of the masseter muscles was reduced in TMD subjects.     

拔除阻生智牙治疗大学生颞下颌关节紊乱病临床效果研究

目的 探讨拔除阻生智牙治疗大学生颞下颌关节紊乱病（temporomandibular disorders,TMD）的临床效果。方法 选择2009年9月以来广东工业大学医院口腔科青年大学生TMD并智牙阻生患者136例,随机分为2组,每组68例,试验组采取心理+药物+局部理疗+阻生牙拔除术等综合治疗,对照组仅采取心理+药物+局部理疗等保守治疗。两组完成治疗后随访观察1年,对比疗效差异。结果 试验组总有效率为91.2%,对照组总有效率78.0%,两组疗效差异有统计学意义（P＜0.05）。结论 拔除阻生智牙对治疗青年大学生TMD有较好的疗效,可列为青年大学生TMD系列治疗方法之一。     

Signs of temporomandibular disorders in tinnitus patients and in a population-based group of volunteers: results of the Study of Health in Pomerania

The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.     

Reorganization of muscle activity in patients with chronic temporomandibular disorders

ObjectiveTo investigate whether reorganization of muscle activity occurs in patients with chronic temporomandibular disorders (TMD) and, if so, how it is affected by symptomatology severity.MethodsSurface electromyography (sEMG) of masticatory muscles was made in 30 chronic TMD patients, diagnosed with disc displacement with reduction (DDR) and pain. Two 15-patient subgroups, with moderate (TMDmo) and severe (TMDse) signs and symptoms, were compared with a control group of 15 healthy subjects matched by age. The experimental tasks were: a 5 s inter-arch maximum voluntary clench (MVC); right and left 15 s unilateral gum chewing tests. Standardized sEMG indices characterizing masseter and temporalis muscles activity were calculated, and a comprehensive functional index (FI) was introduced to quantitatively summarize subjects’ overall performance. Mastication was also clinically evaluated.ResultsDuring MVC, TMDse patients had a significantly larger asymmetry of temporalis muscles contraction. Both TMD groups showed reduced coordination between masseter and temporalis muscles’ maximal contraction, and their muscular activity distribution shifted significantly from masseter to temporalis muscles. During chewing, TMDse patients recruited the balancing side muscles proportionally more than controls, specifically the masseter muscle. When comparing right and left side chewing, the muscles’ recruitment pattern resulted less symmetric in TMD patients, especially in TMDse. Overall, the functional index of both TMDmo and TMDse patients was significantly lower than that obtained by controls.ConclusionsChronic TMD patients, specifically those with severe symptomatology, showed a reorganized activity, mainly resulting in worse functional performances.