垂直距离减小和下颌后移对颞下颌关节的创伤分析

目的 :咬合因素作为颞下颌关节紊乱 (TMD)发病的重要因素 ,目前其致病机理仍不是十分清楚。研究咬合因素对颞下颌关节的创伤过程 ,将有助于我们对其诊断和治疗。方法 :将临床上收集的 ,明确有不良咬合因素的颞下颌关节紊乱的病例共 49例 ,根据其不同的咬合因素归类并临床分期 ,然后作统计学分析 ,同时解剖测量分析 7具尸体颞颌关节盘和髁状突的前后斜面。结果 :病理性的垂直距离减小对TMD发病的影响最大 ,病理性的垂直距离减小和病理性下颌后移关系之间无显著性的差异。结论 :不良咬合关系通过改变颞颌关节正常的受力方式 ,使颞颌关节长期处于微创伤运动中 ,而产生关节结构间的紊乱 ,并反过来加重关节组织的损伤过程     

Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup of degenerative joint disease

Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) as compared with the magnetic resonance imaging (MRI) 'gold standard'. The TMJ DJD group comprised 48 joints in 24 consecutive patients who were assigned a clinical bilateral diagnosis of TMJ DJD. The TMJ non-DJD group consisted of 82 joints in 41 consecutive patients without a TMJ-related diagnosis of TMD. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of degenerative joint changes. An MRI diagnosis of osteoarthrosis (OA) was defined by the presence of flattening, subchondral sclerosis, surface irregularities, and erosion of the condyle or presence of condylar deformities associated with flattening, subchondral sclerosis, surface irregularities, erosion and osteophyte. For the CDC/TMD interpretations, the positive predictive of DJD for OA was 67%, and for the presence of degenerative joint changes 88%. The overall diagnostic agreement for DJD was 44.6% with a corresponding K-value of 0.01. Most of the disagreement was due to false-negative interpretations of asymptomatic joints. The results suggest CDC/TMD to be predictive for degenerative joint changes but insufficient for determination of OA. Patients assigned a clinical TMJ-related diagnosis of DJD may need to be supplemented by evidence from MRI to determine the presence or absence of OA.     

Prevalence of temporomandibular disorder pain,jaw noises and oral behaviours in an adult Italian population sample

To evaluate the prevalence of temporomandibular disorder pain (TMD‐pain), temporomandibular joint (TMJ) noises, oral behaviours in an Italian adult population sample, their possible association with gender, oral behaviours, self‐reported facial trauma and orthodontic treatment. Subjects older than 18 years were recruited from general population in public spaces during their daily life. A specific questionnaire was developed to collect data on TMD‐pain, TMJ noises, oral behaviours, orthodontic treatment and facial trauma. A total of 4299 subjects were included in the study. The most common symptom in the sample was TMJ clicking (30.7%), followed by TMD‐pain (16.3%) and TMJ crepitus (10.3%). Oral behaviours were reported in 29% of the sample; 43.6% of the sample reported a previous or ongoing orthodontic treatment. TMD‐pain and TMJ clicking were significantly associated to gender, oral behaviours and a positive history of previous facial trauma. Crepitus was significantly associated to oral behaviours, facial trauma and higher age. Ongoing orthodontic treatment was significantly associated to TMD‐pain and TMJ sounds. In a general Italian adult population sample, TMD‐pain is associated to female gender and is less prevalent than TMJ clicking. TMDs are associated to trauma and oral behaviours.     

颞下颌关节紊乱病患者与健康人群颌面部机械疼痛敏感性的比较

目的 利用定量触诊仪对受试者双侧咬肌区及关节区进行触诊,比较和分析疼痛性颞下颌关节紊乱病（TMD）患者与健康人群口颌面部机械疼痛敏感性的差异。 方法 选取患有单侧咬肌区或关节区疼痛的TMD患者各40例作为试验患者组,40例健康人作为对照组。利用定量触诊仪在受试者双侧咬肌区或关节区进行触诊,通过口述疼痛模拟评分法（NRS）获得受试者不同检测位点的机械疼痛感觉,绘制机械疼痛敏感性地图,并计算熵值和重心坐标。利用两因素方差分析法分析性别和检查侧（患者组：健患侧;对照组：左右侧）对各组熵值和重心坐标的影响;利用三因素方差分析法分析性别、检查侧和检测位点对各组NRS评分的影响。 结果 TMD患者咬肌区及关节区健患侧熵值均有统计学差异（咬肌：P＜0.001,关节：P=0.006）,且患侧NRS指数显著高于健侧（咬肌：P＜0.001,关节：P＜0.001）;但对照组咬肌区及关节区双侧熵值及NRS指数无明显统计学差异（P≥0.071）。 结论 机械疼痛敏感性地图技术在提供标准化触诊的基础上可以作为区分疼痛性TMD患者及正常人的有效辅助工具,并为该技术应用于TMD患者治疗效果评估的可行性提供了依据。     

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间接性颞下颌关节损伤可以导致颞下颌关节紊乱病(TMD),其发病机制尚未完全阐明,临床缺乏有效的预防和治疗手段。本文从笔者的科研和临床经验出发,对创伤性TMD的发病机制进行了探讨,并对该病的早期防治提出见解。     

Symptoms and signs of temporomandibular disorders and oral parafunctions among Saudi children

This study aimed to record the prevalence of signs and symptoms of temporomandibular disorders (TMD) and oral parafunctions among Saudi children. A questionnaire and a clinical examination of signs and symptoms of TMD were performed on 1940 stratified randomly selected schoolchildren. The sample was divided into three groups, 505 with primary, 737 with mixed and 734 with permanent dentition. The prevalence of TMD signs was found to be 20.7% and the most common sign of TMD was joint sounds (11.8%). The second most common sign was restricted mouth opening (5.3%). Muscle and temporomandibular joint (TMJ) pain as well as deviation upon jaw opening appeared infrequently. TMJ sounds were significantly increasing with age (P < 0.05). TMD symptoms as reported by the parents were evident in 24.2% of the returned questionnaires (1113). The most common symptoms were headache (13.6%) and pain on chewing (11.1%). The incidence of headache was found to be significantly increasing from primary to permanent dentition (P < 0.01). No sex difference in the prevalence of any symptom was reported. Nail biting was the most common oral parafunction (27.7%) while bruxism was the least common (8.4%). All parafunctions except bruxism were significantly related to age. Cheek biting and thumb sucking were reported more in females than in males. The importance of a screening examination for symptoms and signs of TMD should not be overlooked in the clinical assessment of the pediatric patient.     

颞下颌关节增强磁共振成像研究

目的：探讨磁共振对比增强剂Gd—DTPA对颞下额关节紊乱病的临床诊断意义。方法：对12名临床诊断为颞下颌关节紊乱病患进行磁共振增强前后扫描，观察影像增强效果。结果：Gd—DTPA对关节盘位置正常的关节闭口斜矢状位前伸部及张口位双板区具有显的增强效果；对可复性及不可复性关节盘前移位张闭口位前伸部及双板区均有明显的增强效果；对冠状位也有明显增强效果。结论：磁共振对比增强剂的增强效果明确，为提高临床诊断准确性及作为磁共振常规扫描的辅助手段提供理论依据。     

伴颞下颌关节病错畸形的正畸治疗原则与方案

颞下颌关节(TMJ)的生物学特征是适应性改建,主要表现为髁突在咬合状态与下颌位置改变时会引发吸收、增生或修复.错畸形类型与颞下颌关节病(TMD)易感性之间存在关联.总体上,错畸形与TMD易感性从高到低依次为:突面、偏颌、直面、凹面错畸形.在突面畸形中,骨源性与混合Ⅱ型的TMD易感性最高,常表现为突吸退(突面畸形-髁突吸...     

颞下颌关节紊乱病患者口腔不良习惯与髁突骨质改变相关性的影像学研究

目的研究颞下颌关节病患者口腔不良习惯与颞下颌关节髁突骨质改变之间的关系。方法选取诊断为颞下颌关节紊乱病的患者106例,问卷调查患者的口腔不良习惯,并行双侧颞下颌关节锥形束CT成像,分析患者口腔不良习惯与颞下颌关节髁突骨质影像学改变的相关性。结果 106例患者中,口腔不良习惯以偏侧咀嚼、紧咬牙、夜磨牙和喜食硬物较常见。经统计学分析,喜食硬物是出现髁突骨皮质模糊消失型改变的危险因素(P=0.019,OR=2.570)。喜食硬物是髁突前外侧(P=0.025,OR=2.298)、髁突后外侧(P=0.023,OR=2.692)及关节结节(P=0.020,OR=3.067)易出现骨质改变的危险因素。偏侧咀嚼习惯则是关节窝前内侧(P=0.013,OR=0.311)易出现骨质改变的危险因素。结论口腔的不良习惯与颞下颌关节骨质改变的类型及部位有一定相关性。     

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.     

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??Objective    To investigate the relationship between the depth of curve of Spee??COS?? and temporomandibular joint disorders??TMD?? in elderly patients. Methods    Eighty-nine elderly patients with TMD visiting the Hospital of Stomatology of China Medical University from January 2013 to June 2013 were recruited in the study by random number table. Muscle pain and temporomandibular joint??TMJ??sounds were examined according to Research Diagnostic Criteria for TMD??and the depth of COS were measured on the dental casts. The mean depth of COS of patients without muscle pain and patients with pain at all levels were compared??and the unilateral depth of COS of patients with and without TMJ sounds were compared. Related data were analyzed statistically with one-way analysis of variance and t-test. Results           The depth of ipsilateral COS of patients with TMJ sounds was significantly smaller than those of patients without TMJ sounds??left??P < 0.001??right??P = 0.008????while the depth of contralateral COS of patients with TMJ sounds had no significant differences with those of patients without TMJ sounds??left??P = 0.481??right??P = 0.905??. In addition??there were no significant differences between the mean depth of COS of patients without muscle pain and patients with pain at all levels??P = 0.327??. Conclusion    TMJ sounds are closely associated with COS??and the depth of ipsilateral COS of patients with TMJ sounds is smaller??and the COS is flatter. There is no significant association between the mean depth of COS and muscle pain.     

Women with more severe degrees of temporomandibular disorder exhibit an increase in temperature over the temporomandibular joint

Aim

The purpose of the present study was to correlate the degree of temporomandibular disorder (TMD) severity and skin temperatures over the temporomandibular joint (TMJ) and masseter and anterior temporalis muscles.

Materials and methods

This blind cross-sectional study involved 60 women aged 18–40 years. The volunteers were allocated to groups based on Fonseca anamnestic index (FAI) score: no TMD, mild TMD, moderate TMD, and severe TMD (n = 15 each). All volunteers underwent infrared thermography for the determination of skin temperatures over the TMJ, masseter and anterior temporalis muscles. The Shapiro–Wilk test was used to determine the normality of the data. The Kruskal–Wallis test, followed by Dunn’s test, was used for comparisons among groups according to TMD severity. Spearman’s correlation coefficients were calculated to determine the strength of associations among variables.

Results

Weak, positive, significant associations were found between FAI score and skin temperatures over the left TMJ (rs = 0.195, p = 0.009) and right TMJ (rs = 0.238, p = 0.001). Temperatures over the right and left TMJ were significantly higher in groups with more severe TMD (p < 0.05).

Conclusion

FAI score was associated with skin temperature over the TMJ, as determined by infrared thermography, in this sample. Women with more severe TMD demonstrated a bilateral increase in skin temperature.     

Computerized axiography in TMD patients before and after therapy with 'function generating bites'

The study evaluates the temporomandibular joint (TMJ) movements of patients with signs and symptoms of temporomandibular disorders (TMD) before and after therapy with the functional appliances of the 'function generating bite' (FGB) type. Thirty subjects suffering from TMD were selected and divided into two groups: group A (young patients: four males, nine females, mean age +/- standard deviation: 13.3+/-1.5 years); group B (adults: three males, 14 females, mean age +/- standard deviation: 23.2+/-4.4 years). A control group comprised 13 healthy subjects with perfect normal occlusion, TMD-free, was matched for age and sex with patient groups and was examined at T0 and after 12 months (T1). Computerized axiography was performed before and after therapy (average 13 months) with FGBs to evaluate any difference in condyle border movements. Results showed a statistically significant improvement after treatment, for groups A and B, in length, clicks, tracings with normal morphology, superimposition, deviations, regularity and return to starting position and speed (statistical analysis: chi-squared test) except for the symmetry of tracings which was significantly improved only for the young patient group. No statistically significant differences at time T0/T1 were found in the control group. In conclusion, the study shows that the TMJ tracings of TMD patients before and after therapy with 'FGB' significantly improve especially in young patients. FGB may be a useful appliance to improve TMJ function in young and adult TMD patients requiring orthodontic treatment.     

What you can and cannot see in TMJ imaging – an overview related to the RDC/TMD diagnostic system

Summary In the current version (I) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), imaging of the temporomandibular joint (TMJ) is not required for a diagnosis. Research has shown that radiological findings of the TMJ do not always support the clinical findings of the RDC/TMD diagnosis. But imaging should only be performed when it is known that it could contribute to (i) a proper diagnosis and (ii) treatment with a better prognosis. Several techniques are used to image the TMJ: panoramic radiography, plain radiography, conventional and computed tomography (CT), digital volume tomography or cone‐beam computed tomography (CBCT), arthrography and magnetic resonance imaging (MRI). Osseous changes are best visualized in tomography, and the newly developed CBCT is a promising method but must be evaluated in a comparative analysis with other tomographic techniques. And although MRI is the method of choice for imaging the disc, a systematic review found the evidence grade for the diagnostic efficacy of MRI to be insufficient. Today, there is no clear evidence for when TMD patients should be examined with imaging methods. Future research designs should be randomized controlled trials where various radiological examination findings are analysed in relation to therapeutic outcome. In future versions of the RDC/TMD diagnostic system, recommended radiographic techniques must be evaluated and defined, diagnostic criteria well defined and observers calibrated.     

Correlation between cervical spine and temporomandibular disorders

Neuroanatomical interconnections and neurophysiological relationships between the orofacial area and the cervical spine have been documented earlier. The present single-blind study was aimed at screening possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders. Thirty-one consecutive patients with symptoms of TMD and 30 controls underwent a standardised clinical examination of the masticatory system, evaluating range of motion of the mandible, temporomandibular joint (TMJ) function and pain of the TMJ and masticatory muscles. Afterwards subjects were referred for clinical examination of the cervical spine, evaluating segmental limitations, tender points upon palpation of the muscles, hyperalgesia and hypermobility. The results indicated that segmental limitations (especially at the C0–C3 levels) and tender points (especially in the m. sternocleidomastoideus and m. trapezius) are significantly more present in patients than in controls. Hyperalgesia was present only in the patient group (12–16%). Received: 18 January 1998 / Accepted: 29 April 1998     

Clinical TMD, pain-related disability and psychological status of TMD patients

This study investigated the clinical temporomandibular disorders (TMD), pain-related disability and psychological status of TMD patients using a computerized on-line TMD diagnostic system (NUS TMD v1.1). A total of 107 patients (32 male, 75 female) referred to the TMD clinics at the National Dental Centre and National University Hospital participated in this study. The mean age of the predominantly Chinese population (82.2%) was 30.8 years (range from 12 to 64 years). The history questionnaire and clinical examination were input directly into computers by patients and clinicians. A 'Summary of Findings' was then immediately generated by the program based on Axis I and II rules. The data was subsequently exported to SPSS for statistical analysis. About 20.6% of the patients had myofascial pain but only 7.5% experienced limited mandibular opening associated with myofascial pain. The majority of patients (> 80%) did not suffer from disc displacements (right and left joints). The frequency of arthralgia was also low (right joint 8.4%; left joint 7.5%) and only one patient had osteoarthosis of the TMJ. About 78.5% of the patients had low disability with almost equal distribution between low and high intensity pain, 27.1% of the patients were moderately depressed and 11.2% had severe depression. No significant difference in limitations related mandibular functioning scores was observed between normal/depressed patients and between patients with the different graded chronic pain severity classification. The three most frequent jaw disabilities were: eating hard foods (77.6%), yawning (75.7%) and chewing (64.5%). NUS TMD v1.1 is an extremely useful tool in the diagnosis/research of clinical TMD.     

下颌运动轨迹分析在颞下颌关节紊乱病诊疗中的应用及展望

近年来,颞下颌关节紊乱综合征(temporomandibular disorder,TMD)患病率越来越高,且病因复杂.下颌运动轨迹观测能够针对颞下颌关节(temporomandibular joint,TMJ)的运动能力及协调性进行诊断分析,广泛应用于口腔正畸、修复及外科治疗过程中,对TMD的诊断分析及疗效评定具有重...     

Generalized joint hypermobility and temporomandibular disorders: inherited connective tissue disease as a model with maximum expression

AIMS: To study the relationship between generalized joint hypermobility (GJH) and temporomandibular disorders (TMD) by assessing prevalence and patient characteristics of TMD in a population of patients with maximum expression of GJH as a symptom of inherited connective tissue disease. In addition, diagnostic reliability of a series of clinical signs indicative of temporomandibular joint (TMJ) hypermobility was tested. METHODS: The study sample consisted of 42 subjects with GJH, 24 with Marfan syndrome and 18 with Ehlers-Danlos syndrome. A subgroup of 27 individuals was selected by age (> or = 18 yrs) and was compared to 40 controls with TMD and normal peripheral joint mobility. TMD diagnoses were assigned to each subject according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: In the GJH sample (n = 42), 71.4% of the subjects were symptomatic for TMD. Of those, 13.3% had sought treatment. A myofascial pain diagnosis was made in 69%, disc dislocation with reduction was diagnosed in 85.7%, and TMJ arthralgia in 61.9%. Multiple TMD diagnoses were assigned in 69% of the subjects; of these, 57% had 3 or more subgroup diagnoses. Joint noises (P < .01) and recurrent TMJ dislocations (P < .01) were a frequent finding in adult GJH subjects (n = 27) compared to controls, with symptomatic GJH subjects presenting more and more prolonged dislocation events than asymptomatic subjects (P < .001). TMJ hypermobility signs were expressed significantly more often in GJH compared to controls with TMD and normal joint mobility. CONCLUSION: This study indicates a positive relationship between GJH and TMD.     

The treatment of temporomandibular disorders with stabilizing splints in general dental practice: one-year follow-up

BACKGROUND: The authors evaluated temporomandibular disorder (TMD) outcomes in general dental practice one year after treatment with stabilizing splints (SS) or nonoccluding control splints (CS). METHODS: Seventy-two randomly allocated subjects completed initial treatment. The outcomes measures were a pain visual analog scale (VAS), muscle tenderness, temporomandibular joint (TMJ) tenderness, interincisal opening, TMJ clicks and headaches. After initial treatment, 81 percent of the subjects were found to have been treated satisfactorily. The dentists referred the remaining subjects to a dental hospital. At one year, the authors recalled 52 of the original subjects for evaluation. RESULTS: Improvements after initial treatment were maintained at one year for all outcomes, except for TMJ clicking, which returned to pretreatment levels. Eighty-one percent of the subjects rated their treatment as either good or excellent in reducing jaw pain. The authors found that subjects were aware of more of their TMJ clicks than dentists observed at the one-year clinical examination, but most subjects thought their clicking or the associated pain had been reduced. Fifty-five percent subjects had used their splints in the previous six months, but only 31 percent of these had done so daily. There were no significant differences between splint groups. CONCLUSION: At one year, a good response to TMD treatment in general practice had been maintained, but many subjects still had clicking TMJs. CLINICAL IMPLICATIONS: Trained dentists can manage TMD satisfactorily, with only a small proportion of patients needing specialist attention.     

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.