垫治疗青少年颞下颌关节紊乱病的临床疗效分析

目的:考察垫对青少年颞下颌关节紊乱病患者临床症状的改善情况。方法:采用稳定性垫或再定位垫治疗71例颞下颌关节紊乱忠者,比较治疗前后张口度、颌面部疼痛和关节弹响的变化情况。结果:治疗组51例患者中疼痛34例,张口受限15例,疼痛伴张口受限14例,单纯性疼痛20例,治疗后疼痛及张口受限均得到缓解,缓解率为100%。治疗前疼痛指数和张口度分别为7.5±2.09和26.5±5.12mm,治疗后分别为2.4±1.58和40.1±5.03mm,差异均有显著性(P<0.05);关节弹响41例,治疗后18例弹响消失,16例弹响减轻。对照组中有2例弹响自行消失,3例疼痛自行缓解,其余无变化,差异有统计学意义(P<0.05)。结论:垫对颞下颌关节紊乱病患者的临床症状有显著缓解作用。     

Roth诊断垫治疗颞下颌关节紊乱病的初步探讨

目的:观察使用Roth诊断垫治疗颞下颌关节紊乱病(Temporom-andibular disorder,TMD)的疗效。方法:选取76名TMD患者,随机分成2组。治疗组患者24h佩戴Roth诊断垫;对照组患者仅给予TMD健康指导。观察6个月后,应用Fricton颞下颌关节紊乱指数评价TMD患者临床症状。将治疗组和对照组治疗前后差异进行统计学分析。结果:治疗组与对照组治疗前后Fricton指数减少有显著性差异。结论:使用Roth诊断垫治疗某些颞下颌关节紊乱病有明显效果。     

颞下颌关节紊乱病的治疗

关于 因素是否颞下颌关节紊乱病（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。     

垫治疗青少年颞下颌关节紊乱病的临床疗效分析

目的：考察[牙合]垫对青少年颞下颌关节紊乱病患者临床症状的改善情况。方法：采用稳定性[牙合]垫或再定位[牙合]垫治疗71例颞下颌关节紊乱患者，比较治疗前后张口度、颌面部疼痛和关节弹响的变化情况。结果：治疗组51例患者中疼痛34例，张口受限15例，疼痛伴张口受限14例，单纯性疼痛20例，治疗后疼痛及张口受限均得到缓解，缓解率为100％。治疗前疼痛指数和张口度分别为7．5±2．09和26．5±5．12mm，治疗后分别为2．4±1．58和40．1±5．03mm，差异均有显著性（P〈0．05）；关节弹响41例，治疗后18例弹响消失，16例弹响减轻。对照组中有2例弹响自行消失，3例疼痛自行缓解，其余无变化，差异有统计学意义（P〈0．05）。结论：[牙合]垫对颞下颌关节紊乱病患者的临床症状有显著缓解作用。     

错畸形与颞下颌关节紊乱病

颞下颌关节紊乱病(TMD)是由多因素引起的疾病,其中因素是重要的病因。关系异常可以引起TMD的症状,而错畸形矫正以后TMD症状明显减轻。亦有认为TMD与关系错乱没有直接关系,即所说的没有影响或仅有轻微影响。本文对TMD的临床表现,病因、治疗及预后等方面进展进行综述。     

稳定型咬板治疗颞下颌关节紊乱病疼痛的疗效观察

作者应用稳定型咬板治疗 30 2名颞下颌关节紊乱病 ( TMD)患者 (其中 2 0 7人单侧 ,95人双侧 ,总共 397例 )。该疗法对 TMD疼痛的总有效率为 80 .3% ,对嚼肌、颞肌、翼外肌疼痛的平均总有效率为 86 .1 %。认为稳定型咬板通过阻断干扰的激惹因素 ,缓解肌痉挛 ,从而解除疼痛。它对治疗颞下颌关节紊乱病肌功能紊乱所造成的疼痛具有较好的疗效     

颞下颌关节紊乱指数临床应用评价

目的 探讨如何采用客观定量的方法评价颞下颌关节功能障碍程度和颞下颌关节紊乱病（temporomandibular disorders,TMD）的治疗效果。方法 分别采用Fricton颞下颌关节紊乱指数和Helkimo临床检查功能障碍指数，定量计算每例患者（共60例）的颞下颌关节紊乱指数，评价不同检查者获得的各项指数的一致性，并应用Fricton颞下颌关节紊乱指数定量评价TMD急性不可复性盘前移位的临床治疗效果。结果 （1）不同检查者获得的各项Fricton紊乱指数值相近；（2）Fricton紊乱指数可明确反映TMD急性不可复性盘前移位治疗后临床功能的改善。结论 评价TMD功能障碍程度或评价TMD治疗效果宜避免使用非客观的、描述性的报告，Fricton紊乱指数是一方便且有效的客观定量指标。     

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.     

关节腔冲洗治疗颞下颌关节紊乱病疗效观察

目的 观察关节腔冲洗治疗颞下颌关节紊乱病的疗效。方法 对68例颞下颌关节紊乱病患者的关节腔内使用大量生理盐水反复冲洗后，注入1％醋酸曲安缩松0．5ml和2％利多卡因0．5ml混合液，两周后复查，观察治疗效果。结果 结构紊乱病显效3例，好转11例，无效4例；滑膜炎显效8例，好转14例，无效1例；骨关节病显效5例，好转11例，无效3例。结论 该疗法对结构紊乱病患者疼痛和开口受限有较好的疗效，但对盘移位引起的弹响则效果欠佳。激素的使用不宜次数过多，应有一定的适应症。     

颞下颌关节紊乱综合征的治疗──286例临床分析

障碍是颞下颌关节紊乱综合征的重要病因之一，治疗是本病的重要治疗手段。本组286例病例在确定有股因素以后，按照张震康等修正的Clark的治疗程序，在温和的保守治疗与有针对性的保守治疗的基础上进行治疗（包括调、戴板166例．正畸治疗31例、修复后牙缺失71例），收到了较好的效果（有效率84．2％）。本文就戴板的适应范围、作用原理等进行了简要讨论。     

Clinical findings in temporomandibular disorders

71 patients (16 males and 55 females) with temporomandibular (TM) disorders were examined for clinical symptoms of mandibular dysfunction. The frequency of TM disorders in the present study was higher in females (55 females, 77.5%) than in males (16 males, 22.5%); the ratio of females to males was about 3.4:1. The most frequent chief complaint was pain; limitation of opening movement was the next most common. Many patients had several of the major symptoms simultaneously. TM joint sounds were noted in 47 patients, including reciprocal clicking in 35 patients and crepitation in 12 patients. Tenderness with palpation of the TM joint and muscles were found in 46 patients; most of them complaining at two positions or more. Occlusal interferences were noted in various occlusal positions, and occlusal wear was found in 30 patients (42.3%). In recording the frequency of parafunction and bad habits, grinding of the teeth was found in 6 patients (8.5%), clenching of the teeth in 10 (14.1%), and unilateral mastication in 24 (33.8%).     

Additive effects of different stressors on temporomandibular disorders

A review of dental literature has been made on the etiologies of Temporomandibular dysfunction (TM). Many authors have given different explanations for TM dysfunction and recommended different treatment modalities for it. There has been considerable diversity of opinion concerning the etiology and proper treatment in both dentistry and medicine.TM dysfunction is often multifactorial in nature and may require expertise from several different professional fields for its successful treatment. This paper presents a model which explains the additive effects of different stressors that contribute to Temporomandibular disease. As more and more stressors are added to a patient's life, the patient becomes more and more likely to develop symptoms. Successful TM treatment requires the identification and elimination of as many contributing factors as possible. This paper gives an explanation of the theory, discusses some stressors, and presents a rationale for the conservative treatment of Temporomandibular disorders. There has been much investigation into and discussion of the etiology of and appropriate treatment modalities for Temporomandibular Disorders (TMD). Many different theories of etiology have been brought forward and have much value for the practitioner and patient. There is considerable diversity of opinion as to primary causative factors and, therefore, the most appropriate treatment. It is widely accepted that Temporomandibular Disorders (TMD) are multifactorial. The significance of the phrase "multifactorial etiology" may not be fully appreciated by some. This lack of appreciation is suggested from the significant polarization in dentistry and medicine concerning the etiology and appropriate treatment of Temporomandibular Dysfunction (TMD). Following is an explanation that. might unite different groups in dentistry and medicine into a more complete understanding of Temporomandibular Disorders.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of seasonal changes on temporomandibular disorders

The aim of our study was the evaluation of seasonal influences on development and evolution of temporomandibular disorders (TMD). In a retrospective study based on data from 1997 and 1998, we analyzed the monthly number of patients at the Department of Prosthodontics. The total number of first time examinations during these two years was 11,747. Nine hundred and sixty-one (961) patients showed symptoms frequently found in TMD. These patients were submitted to a special TMD diagnosis based on the criteria of a validated craniomandibular index questionnaire. In 568 patients (group A1), a TMD was confirmed, in the other 393 patients (group A2), the disorder could not be confirmed. Dividing up the numbers of patients into summer and winter half years, we found statistically significant relationships between patient numbers and season in TMD patients (A1) as well as in all patients (group B). The distribution of the monthly numbers of TMD patients with its maximum in winter, however, was characteristically different from that of all patients with the maximum in summer. The number of TMD patients per month was significantly correlated to the mean daily sunshine duration per month. Parallels could be drawn to seasonal variations of symptoms in Seasonal Affective Disorders (SAD). As the mechanisms which influence the emergence of psychologically impacted disease in TMD patients might be comparable to SAD, we propose that a similar therapy may be applied.     

Clinical decision making for temporomandibular disorders.

Temporomandibular Disorders (TMD) encompass a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ), or both. In any given patient, there exists the possibility of several overlapping TM disorders, an orofacial pain condition mimicking a TMD, or a concomitant TMD and non-TMD disorder. Since differential diagnosis involves the determination of which diseases or disorders a patient is suffering from by systematically contrasting the clinical characteristics, differentiation from among multiple possible conditions complicates the diagnostic process, which often must be approached with a certain degree of uncertainty. In addition, the therapeutic decisions that emanate from the diagnostic process have their own predictive uncertainties. These uncertainties can be ameliorated by coupling available clinical research data with structured clinical problem solving methods during the diagnostic-therapeutic decision making process. It is within this context that this article includes a discussion of the rationale for why the clinician should use decision making methods for TMD, a review of previous attempts at developing decision models for TMD, a discussion of the diagnosis of TMD with particular emphasis on the reliability and validity of their diagnostic criteria, a summary of the efficacy of therapeutic modalities and their application to treatment decisions, a sample decision tree analysis of a TM disorder, and some general recommendations for dental education.     

Clinical implications of sex in acute temporomandibular disorders

BACKGROUND: Previous research on temporomandibular disorders, or TMDs, has been somewhat limited, with studies having low numbers of subjects, restricting the focus to women or looking at patients already diagnosed with chronic TMD. Because early intervention is beneficial, it is important to understand the symptoms that men and women have in the acute stage of TMD. METHODS: A total of 233 patients (161 women, 72 men) with acute TMD symptoms were assessed with a battery of biopsychosocial measures. Patients were diagnosed as having TMD on the basis of research diagnostic criteria, or RDC, or RDC, for TMD. After six months, patients were reassessed to determine whether they continued to have pain, thus classifying them as having chronic TMD. The authors found that 153 patients (47 men, 106 women) had developed a chronic condition, while 80 patients (25 men, 55 women) no longer reported pain (nonchronic). RESULTS: Female and male patients who developed chronic TMD differed significantly from patients who had acute symptoms that subsided. Women who developed chronic TMD exhibited significantly more psychosocial distress and impairment than women who did not develop chronic TMD, in terms of Diagnostic and Statistical Manual, Fourth Edition, or DSM-IV, diagnoses; Beck Depression Inventory, or BDI, scores; Minnesota Multiphasic Personality Inventory scores; Multidimensional Pain Inventory, or MPI, scores; and physical and psychological measures assessed with the RDC for TMD. Men who developed chronic TMD differed significantly from men who did not develop chronic TMD, in that they exhibited more impairment in terms of DSM-IV diagnoses and BDI and RDC measures. CONCLUSIONS: These findings provide evidence that significant differences exist between men and women in regard to acute TMD symptoms. CLINICAL IMPLICATIONS: The biopsychosocial differences between men and women suggest that some treatments may be more beneficial for women than for men.     

Cyclic effects on experimental pain response in women with temporomandibular disorders

AIMS: Since cyclic effects on experimental pain response in women with temporomandibular disorders (TMD) have not been adequately studied, the aim of this study was to assess variations in experimental pain response at 4 phases of the menstrual cycle. METHODS: Eighteen normally cycling women with TMD, 25 women with TMD and taking oral contraceptives (OC), 25 normally cycling pain-free controls, and 26 pain-free controls taking OC underwent 3 experimental pain procedures at 4 phases during each of 3 menstrual cycles. These procedures included algometer palpations at fixed amounts of pressure and pressure pain thresholds at several body sites, and an ischemic arm pain task. Repeated measures analysis of variance was used to compare cycle phase, TMD group, and OC status differences in experimental pain response. RESULTS: Significant phase-related differences were seen for palpation intensity measures (P values < .05). Normally cycling women with TMD showed higher palpation pain intensity at menses and midluteal phases, while women with TMD taking OC showed stable palpation pain intensity ratings at menses, ovulatory, and midluteal phases, with increased intensity at the late luteal phase. TMD subjects had greater palpation pain and ischemic pain intensity and lower pressure pain thresholds compared to controls. CONCLUSION: Phase-related differences in experimental pain response were not strong and were more often found for experimental stimuli with greater clinical relevance (ie, palpation pain) compared with an ischemic pain task.     

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颞下颌关节紊乱病(TMD)病因复杂,目前尚不很清楚。最初提出、且目前仍认为比较正确的是因素学说。20世纪60年代初提出精神心理因素学说,被很多学者认可,但却无法被完全认同。后来又提出创伤因素学说、自身免疫因素学说、解剖因素学说等,这些学说都有不足之处。现在一般认为是多种因素引起TMD。     

The effects of two methods of Class III malocclusion treatment on temporomandibular disorders

The aim of this research was to evaluate, within a controlled clinical study, the effects of a Delaire-type facemask or a modified Jasper Jumper (JJ) used in the treatment of children with Class III malocclusions due to maxillary retrognathia on temporomandibular disorders (TMDs). Forty-six patients with Class III malocclusions referred for orthodontic treatment were divided into two groups, a test and a control. The test group comprised 33 randomly chosen patients (15 females, 18 males) aged 8-11 years. The control group included 13 patients (eight females, five males) with similar features. TMD assessment was performed before and after treatment using a two-axis questionnaire, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMDs). Qualitative data were evaluated using chi-square and McNemar tests. No statistically significant differences related to the presence of TMD were observed pre- or post-treatment (P > 0.05). The most commonly encountered diagnosis was arthralgia in the JJ group both before and after treatment. Evaluation of joint and muscle regions showed decreased symptoms, apart from the diagnosed discomforts, in the JJ group (P < 0.05). Reduced symptoms were observed in the Delaire group; however, this reduction was not statistically significant. An increase, not considered to be statistically significant, was observed in the control group. The Delaire-type facemask and modified JJ used in the early phase of Class III malocclusion treatment did not result in TMD.