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。     

Non-compliance in patients with temporomandibular joint dysfunction

In a series of 367 patients complaining of temporomandibular joint dysfunction (TMJD) 78 individuals did not attend after their first or third visits. These non-complaint patients (subjects) were compared with patients completing treatment (controls) by means of a questionnaire. The results suggest that the reasons for non-compliance were a reluctance to wear an appliance particularly at night. The effect of excluding such patients from the analysis of clinical data is noted.     

Single portal arthroscopic temporomandibular joint discopexy: Technique and results

The aim of the present study is to assess the outcomes of monoportal arthroscopic disc repositioning (discopexy) for disc displacement of the temporomandibular joint.A retrospective, single-institutional clinical study included patients with temporomandibular joint internal derangements diagnosed and treated by monoportal discopexy. Each patient was diagnosed as having anterior disk displacement with or without reduction. The arthroscopy treatment consists of one portal approach fixing the disc with a 3/0 nylon to the tragus cartilage without anterior liberation. Arthroscopy surgery was carried out with a 1.9-mm 0° arthroscope and only one simple cannula. We use a needle to pierce of the disc through the skin and retrieve the suture inside the joint using a blind method through the arthroscopic cannula. The evaluated variables included the maximum interincisal opening, the presence of clicking and pain score.A total of 19 patients, 21 joints, were included in the present study. Of the 21 joints, 16 were classified as disc displacement with reduction and 5 without. Visual analogue scale (VAS) values (0–10) decreased from 5.5 to 1.26 (p < 0.0001) 1 year after surgery. At the first review, all patients had a VAS of at least 4 points less than before the surgery, four patients showed a VAS of 0, and nine patients near to 1. Mouth opening increased from 36.6 (±8.09) mm to 39.37 (±4.35) mm, and no significant limitations in the mouth opening range were seen (p < 0.12) 1 year after surgery. Clicking disappeared in all patients and remained stable after 12 months of follow-up. Postoperative magnetic resonance imaging demonstrated a correct or improved position of the disc in all but one patient.A minimally invasive single portal arthroscopic discopexy is an effective technique to improve function and pain reduction in patients with anterior disk displacement with or without reduction.     

基于光谱CT的钙抑制技术评估颞下颌关节紊乱病患者关节盘位置

目的探索钙抑制光谱CT技术在评估颞下颌关节盘位置及测量关节盘后带厚度中的应用。方法对2019年2至7月解放军总医院海南医院放射科门诊就诊的23例颞下颌关节紊乱病患者[平均年龄23岁(12~62岁),男性14例,女性9例]行MRI斜矢状位、斜冠状位质子密度加权成像及光谱CT扫描,共纳入可评估关节45侧,依扫描设备分为MRI测量组及钙抑制光谱CT测量组。采用钙抑制算法对光谱CT进行去钙处理,并重建斜矢状位及冠状位钙抑制光谱CT图像。基于斜矢状位及冠状位图像评估关节盘位置,基于斜矢状位图像测量关节盘后带最大厚度。结果45侧颞下颌关节盘位置在MRI图像及钙抑制光谱CT图像上基本一致。MRI测量组与钙抑制光谱CT测量组所测后带厚度的组内相关系数为0.843(0.712,0.914),Bland-Altman图分析MRI与钙抑制光谱CT测量关节盘后带厚度的差值点[95.6%(43/45)]位于95%一致性界限内。Wilcoxon配对检验提示MRI测量组[2.57(1.76,3.65)mm]与钙抑制光谱CT测量组[2.67(1.74,4.56)mm]差异无统计学意义(P=0.07)。结论钙抑制光谱CT成像可以准确评估关节盘位置及关节盘后带厚度。     

Immunohistochemical analysis of IL-1 beta in the discs of patients with temporomandibular joint dysfunction

Purpose: Interleukin-1 beta (IL-1β) is a cytokine that participates in the regulation of immune responses and inflammatory reactions. It is hypothesized that IL-1 levels may be elevated in patients suffering from temporomandibular joint dysfunction. The purpose of this study was to determine the association of IL-1β expression with TMD using an immunohistochemical approach to evaluate the joint disc.

Materials and methods: A total of 39 human temporomandibular joint disc samples were collected, with 31 samples in the test group. Nineteen of the test group samples were from discs of patients with anterior disc displacement with reduction, and 12 of the samples were from patients with anterior disc displacement without reduction. Eight control samples were used in the control group. The samples were immunostained and evaluated on both quantity and intensity of staining.

Results: There was a statistically significant difference (p < 0.05) between the control and test groups for both quantity and intensity of staining.

Conclusion: IL-1β plays a role in the inflammatory process and degradation of TMJ discs in patients with TMJ dysfunctions.     

Correlation of somatization,depression, and chronic pain with clinical findings of the temporomandibular disorders in asymptomatic women

ABSTRACT

Objective: The aim of this study was to correlate degree of depression, somatization, and chronic pain in asymptomatic women with clinical findings, using Research Diagnostic Criteria/Temporomandibular disorders (RDC/TMD).

Methods: A total of 200 female participants, ages 18–65, filled out a standard RDC/TMD axis II form for the assessment of chronic pain, disability, depression, and non-specific physical symptoms and underwent clinical examination of the temporomandibular joint. Correlation of clinical findings (axis I) and axis II assessment was performed using Spearman’s correlation test, with significance set at p < 0.05.

Results: There was a significant correlation between depression scores (p < 0.04), chronic pain (p < 0.001), and non-specific physical symptoms without questions about pain (p = 0.008).

Discussion: The highest scores on the Graded Chronic Pain Scale were observed in patients with arthralgia, while patients with myofascial pain scored higher on depression and somatization tests.     

Cervical posture analysis in dental students and its correlation with temporomandibular disorder

Objective: To evaluate the relationship between temporomandibular disorders (TMD) and craniocervical posture in the sagittal plane measured from lateral radiographs of the head.

Methods: The sample was comprised of 80 randomly selected students of dentistry at the Federal University of Rio Grande do Norte. Research Diagnostic Criteria for TMD (RDC/TMD) was used to evaluate the signs and symptoms of TMD. Lateral radiographs of each individual were used to measure the position of the hyoid bone, the craniocervical angle, and the occiput–atlas distance. A chi-square test was used to evaluate the relationships between craniocervical posture measures and TMD.

Results: No relationship was found between TMD and the craniocervical posture measured by the positioning of the hyoid bone, head rotation, and the extension/flexion of the head (p > 0.05).

Conclusion: It can be concluded, therefore, that no relationship exists between cervical posture in the sagittal plane and TMD.     

Current panorama of temporomandibular disorders' field in Brazil

In 2012, the recognition of the specialty of Temporomandibular Disorders and Orofacial Pain completed ten years. Given this scenario, it is extremely important to track the current situation of this field of knowledge in Brazil, specifically in the area of research and training. We hope to discuss the importance of the recognition of this specialty and the inclusion of these subjects in undergraduate programs in Dentistry.

Objective

The objective of this study is to perform a bibliometric survey of researches regarding Temporomandibular Disorders and Orofacial Pain conducted in the country, determine the number of specialization courses in Orofacial Pain and the number of specialists in the field.

Methods

The bibliometric survey was conducted based on the Dissertations Portal of Coordination for the Improvement of Higher education Personnel (CAPES) and on PubMed. The panorama of the field of Orofacial Pain and Temporomandibular disorders in Brazil was determined by searching on the website of the Brazilian Council of Dentistry.

Results

We found 731 theses and dissertations with Temporomandibular Disorders and Orofacial Pain as the main subjects; 81 accredited/recognized Courses on Orofacial Pain and Temporomandibular Dysfunction completed; 8 accredited/recognized Specialization Courses on Orofacial Pain and Temporomandibular Dysfunction still in progress, and 1,064 registered specialists in Orofacial Pain and Temporomandibular Dysfunction in the Brazilian Council of Dentistry. Search in the PUBMED database yielded 576 articles published with the participation of Brazilian researchers as first authors and/or co-authors in the period from 2000 to 2013. From this amount, only 5 were published in Portuguese, while all the others were published in english. We can also notice that the number of published articles increases over time.

Conclusion

The number of researches related to temporomandibular disorders has increased over the last ten years, as well as the number of specialization courses and the number of specialists, which represents a major breakthrough for this field of knowledge.     

352名无牙颌老年人颞下颌关节紊乱病调查

目的 对无牙颌老年人颞下颌关节紊乱病( temporomandibular disorders,TMD)的情况进行调查并初步探讨相关的危险因素.方法 352名北京市无牙颌老年人参加本次调查,男性198人,女性154人.根据Helkimo指数设计调查表,由专业培训人员对受试者进行颞下颌关节相关症状和体征的检查并记录.根据性别以及是否进行全口义齿修复分别统计分析.结果本组人群TMD查体阳性率为43.2％(152/352),其中阳性体征以关节弹响多见,占34.1％( 120/352);下颌运动偏斜次之,占18.2％(64/352),关节区及咀嚼肌触痛则发生较少,下颌运动痛最少.男性TMD查体阳性率为36.9％(73/198),女性为51.3％(79/154),两者差异有统计学意义(P =0.0067 ＜0.01);行全口义齿修复的无牙颌老人TMD查体阳性率为38.6％(91/236),未修复者TMD查体阳性率为52.6％(61/116),两者差异有统计学意义(P =0.0125 ＜0.05),其OR值为1.767(1.130～2.763).结论 性别因素及不良咬合均可能是影响老年无牙颌者TMD患病率的危险因素.     

The role of occlusal factors on the occurrence of temporomandibular disorders

Aims:

The aim of this study was to investigate the relationship between occlusal factors and temporomandibular disorders (TMD).

Methodology:

One hundred patients were selected among those who sought medical or dental care in public practice in Recife, Brazil. The presence of malocclusions and absence of five or more posterior teeth were evaluated by the clinical exam. TMD diagnosis was given using Research Diagnostic Criteria (RDC/TMD). Statistics were carried out using Fisher and Mann–Whitney methods with 5% significance level, as well as multiple logistic regression analysis.

Results:

The sample was mainly comprised of women (83%), individuals over 30 years old (57%) and singles (53%). The percentage of TMD and malocclusion in total sample was 42% and 50%, respectively, while in TMD subjects, malocclusion was present in 38·1%. There was no association between TMD and the occlusal factors studied.

Conclusion:

It can be concluded that malocclusion and loss of five or more posterior teeth does not contribute to TMD.     

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     

Comparison of clinical outcomes of treatment of dysfunction of the temporomandibular joint between conventional and ultrasound-guided arthrocentesis

Patients with disorders of the temporomandibular joint (TMJ) who do not respond to non-operative treatment may require invasive procedures such as arthrocentesis and arthroscopy. We divided 80 patients with dysfunction of the TMJ into two groups: a control group who were treated by conventional arthrocentesis, and an experimental group who were treated by ultrasound-guided arthrocentesis. Both groups were monitored three days, one week, and one month postoperatively and the clinical outcomes compared. The experimental group had a significant reduction in the degree of pain in the immediate postoperative period (p = 0.015). However, ultrasound-guided arthrocentesis showed no significant improvement in symptoms overall compared with conventional arthrocentesis. Both techniques seem to be effective in the management of dysfunction of the TMJ.     

Constancy of clinical signs in patients with mandibular dysfunction

Repeated clinical examinations were performed 6 weeks apart on 34 patients with mandibular dysfunction to estimate the consistancy of clinical signs. The clinical examination of the patients included the masticatory muscles, the temporomandibular joint (TMJ) and the mandibular movement capacity. The clinical dysfunction index (Di) was calculated as a measure of the degree of mandibular dysfunction. The highest agreement between examinations was found for maximal mouth opening and protrusion. The agreement for palpation tenderness of the masticatory muscles and TMJ, limited movement of the TMJ, TMJ sounds, and pain during movement was considerably lower. The lowest agreement within 6 weeks was found for the clinical dysfunction index. No statistically significant difference could be detected between the two examinations for any of the clinical signs, as a result of given information and counseling before the 6-week period. It was concluded that all clinical signs, except maximal mouth opening and maximal protrusion, showed low consistancy.     

A clinical and tomographic study on temporomandibular joint osteoarthritis

One hundred and twenty two patients with temporomandibular joint (TMJ) disorders were examined by lateral and frontal tomograms. A comparison between clinical and radiographic findings was performed to confirm the clinical characteristics of TMJ osteoarthritis. The patients with radiographic abnormal or suspicious findings showed a significantly higher frequency of TMJ pain and limitation of mouth opening less than 29mm than the patients with normal findings. The TMJs with surface erosion also showed a significantly higher frequency of TMJ pain than the TMJs with normal findings. Therefore, these findings were thought to be one of the distinctive feature of TMJ osteoarthritis. However, 22 patients with unilateral clinically primary symptoms presented bilateral abnormal or suspicious findings and 7 patients with unilateral clinically primary symptoms presented abnormal or suspicious findings only in the TMJ opposite to the clinically primary symptomatic site. Therefore, the necessity of radiographic examination of the clinically unaffected TMJ was concurrently indicated for the treatment planning and for the further research. Dr. Yamada was the Professor of the Department of Oral Radiology April 1982–March 1991     

The teaching of temporomandibular disorders and orofacial pain at undergraduate level in Brazilian dental schools

Objectives

Evaluate the way the topics for the study of pain mechanisms in general, and Orofacial Pain (OFP) and temporomandibular disorders (TMDs) more specifically, are addressed in undergraduate courses curricula, and also to verify the existence of specialist OFP/TMD teachers in Brazilian dental schools.

Methods

Between July 2010 and January 2011, course Coordinators/Directors of all dental schools duly registered at the Ministry of Education were invited to answer a questionnaire on topics related to OFP/TMD teaching in their institutions.

Results

Fifty-three dental schools representatives answered the questionnaire. The study of pain mechanisms was found to cover an average of less than 10% of the courses'' total time. Pharmacology, Endodontics and Physiology were identified as the departments usually responsible for addressing pain mechanisms in dental courses. Psychosocial aspects were found to occupy a very small proportion in the syllabi, while most of the content referred to biological or somatic aspects. OFP/TMD is addressed by a specific department in only 28.4% of the participating dental schools, while in most cases (46.3%), OFP/TMD is under the responsibility of the Prosthodontics department. Only 38.5% of respondents indicated that they had a specialist OFP/TMD teacher in their Schools.

Conclusion

Among the Brazilian dental schools participating in the study, the teaching of OFP/TMD was found to be insufficient, segmented or with an extremely restricted focus. This initial assessment indicates that Curricular Guidelines for the study of OFP/TMD at undergraduate dental schools should be developed and implemented to facilitate their appropriate inclusion into the curricula and in specific pedagogical projects.     

颞下颌关节紊乱病患者的症状自评量表调查

目的通过对颞下颌关节紊乱病（TMD）患者的症状自评量表（SCL-90）各因子进行分析，了解其精神心理状态。方法338例就诊于北京大学口腔医学院颞下颌关节病及口颌面痛诊治中心的TMD患者填写SCL-90，采用t检验和单组设计定量资料的多元方差分析，将患者和普通人群的SCL-90各因子得分进行比较。结果①TMD患者SCL-90中的躯体化、强迫、焦虑、敌意、恐怖、精神病性因子得分高于普通人群，差异有统计学意义（P〈0．05）；②伴有精神心理障碍的TMD患者比例为23％；③对338份患者SCL-90进行可靠性分析，得出可靠系数为0．958。结论我国TMD患者的精神心理障碍问题不容忽视。SCL-90作为判断TMD患者是否伴有某些精神心理障碍的量表，在我国同样具有较好的适用性。     

颞下颌关节紊乱病关节液雌二醇及骨钙素的检测及其临床意义

目的 检测颞下凳关节滑液中骨钙素及雌二醇半探讨其在颞下颌关节紊乱病中的意义。方法 采用放射免疫分析法分别对31侧及42侧颞下颌关节紊乱病患者关系液中骨钙素及雌二醇进行了测定,并分析了滑液骨钙素及雌二醇水平与TMD关系。结果 结构紊乱类滑液骨钙素浓度与正常对照组无明显差异（P＞0.05）,而OA类滑液骨钙素浓度比正常对照组及结构紊乱类明显增高（P＜0.05）。结论紊乱类与OA类关节液中E2浓度无明显差异,但均比对照组明显高。TMD患者中骨质硬化改变者滑液E2浓度明显高于其它类骨质改变者。结论 雌激素在颞下颌关节紊乱病的发生发展中起一定作用。高浓度滑液E2可能与关工骨质增生硬化相关。颞下颌关节骨关节病与局部同有转换增高及骨代谢异常有关,骨钙素可能是TMD骨改变的标志物之一。     

Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine

The aim of this evaluation was to examine correlations between internal derangement of the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A prospective controlled clinical study was carried out. Thirty patients with signs and symptoms of internal derangement but without any subjective neck problems and 30 age- and gender-matched control subjects without signs and symptoms of internal derangement were examined. The investigation of the temporomandibular system was carried out using a 'Craniomandibular Index'. Afterwards an examiner-blinded manual medical investigation of the craniocervical system was performed. This included muscle palpation of the cervical spine and shoulder girdle as well as passive movement tests of the cervical spine, to detect restrictions in the range of movement as well as segmental intervertebral dysfunction. The internal derangement of the TMJ was significantly associated with 'silent' CSD (t-test, P < 0.05). Patients with raised muscle tenderness of the temporomandibular system exhibited significantly more often pain on pressure of the neck muscles than patients without muscle tenderness of the temporomandibular system (t-test, P < 0.05). As a result of the present study, for patients with internal derangement of the TMJ an additional examination of the craniocervical system should be recommended.     

The prevalence of temporomandibular joint dysfunction among patients wearing complete dentures

This study investigates the prevalence of temporomandibular joint dysfunction among complete denture wearers and relates the incidence to various features.