Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists

PurposeMost of the reports on instrumentalists'' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively.ResultsOverall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours.ConclusionThe results indicate that playing instruments can play a contributory role in the development of TMD.     

Prognostic factors for long-term results after condylar head fractures: A comparative study of non-surgical treatment versus open reduction and osteosynthesis

This longitudinal study compared functional, anatomical, and quality of life (QoL) outcomes after closed reduction (CR) versus open reduction and internal fixation (ORIF) of condylar head fractures (CHFs). The aim was to determine predictability of results and to establish prognostic factors for poor outcomes, thus allowing therapeutic decision making between CR and ORIF.All fractures of the non-surgical group were treated by CR with maxillomandibular fixation (CR-MMF) according to an managed analogically. Morphological and functional results were acquired using axiography and clinical functional diagnostics, as well as MRI in problematic cases. Outcomes were compared with those of a collective of patients treated by ORIF with small fragment screws (SFS), according to a uniform standard.A total of 26 patients with 29 unilateral and bilateral CHFs of the non-surgical group were examined over a period of 28.5 months after completion of therapy and compared with a collective of 54 patients with 73 CHFs treated by ORIF. Statistically significant differences were found between both groups in protrusion and mediotrusion on the fracture side, in favour of ORIF. Significantly more patients in the ORIF group were symptom free in terms of the Helkimo dysfunction index and the RDC TMD compared with conservatively treated patients. Associations between Angle class and Helkimo dysfunction index, and between occlusion or number of teeth and pain after CT, could be confirmed.Given their respective indications, both treatment options demonstrated acceptable results in the majority of cases. However, for therapeutic decision making, it is crucial that the long-term results after CR are significantly less predictable. Our study showed only few positive prognostic factors for a stable functional outcome after CR such as isolated CHFs with stable occlusal conditions in younger patients (<25 years).     

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.     

TMD患者与常模及内外科疾病患者心理健康水平的对比研究

目的：探讨TMD患者是否存在较特异的精神心理特征。方法：采用症状自评量表（SCL-90）分别对TMD患者（44例）、肢体骨折患者（45例）、肾炎和白血病患者（47例）、进行量表调查。结果：TMD患者与常模的阳性项目数及强迫、焦虑、敌对、恐怖、偏执、精神病性等反映心理健康水平的因子有显著性差异。结论：心理因素与TMD患者之间有明显相关关系。     

经皮电刺激治疗颞下颌关节紊乱

目的 :观察经皮电刺激(TENS)治疗颞下颌关节紊乱疗效。方法 :采用TENS及He -Ne激光 (对照组 )治疗颞下颌关节紊乱 ,两组分别为70颞/67例和70颞/68例。结果 :TENS组及对照组治疗前后总痊愈显效率及有效率分别为88.6 %、97.1 %和82.9 %、95.7 % ,经统计学处理 ,差异均无显著性意义 ( P >0.05)。疗程10次以内的患者 ,TENS组45例 (46颞下颌关节 ) ,对照组41颞/40例 ,痊愈显效率分别为89.1 %和70.7 %(P<0.05) ,平均治疗次数分别为(5.4±2.0)和(6.7±2.0)(P<0.05) ,两组相比均有显著性差异。结论 :TENS可有效治疗颞下颌关节紊乱 ,见效较He -Ne激光快。     

伴颞下颌关节紊乱病的成人正畸患者的人格特征

探讨伴颞下颌关节紊乱病（TMD）的成人正畸患者的人格特征,为正畸临床诊治此类患者提供参考依据。方法：采用艾森克人格问卷（EPQ）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的成人错牙合畸形人群（对照组）进行测试,测试结果进行t检验。结果：EPQ人格因素问卷测量显示伴TMD的成人正畸患者N量表（神经质）和P量表（精神质）与对照组存在统计学意义（P＜0．05）。结论：伴颞下颌关节紊乱病的成人正畸患者倾向于神经质和精神质的人格特征。     

Pantographic reproducibility of mandibular border movements in patients with craniomandibular disorders

The change of the reproducibility of maximum border movements in patients with CMD has been studied in the United States. Clayton and others reported a change of PRI, pantographic reproducibility index. There is no information on this in the Japanese population. Also, there is found no study on each section of a scribed line, pantographic reproducibility value (PRV). The purpose of this study is to analyze each section’s characteristics with a Japanese population. 30 craniomandibular disorder patients were used in study. The Denar pneumatic pantograph has used. The average PRI before treatment was 35.5 and after treatment was 14.8 Statistically significant correlation (r=0.56) was found in PRI between before and after treatment. All 12 sections showed a stasistically significant difference in PR value between before and after treatment. Sensitive sections were: 1. posterior horizontal rotating path early part; 2. posterior horizontal orbiting path later part; 3. posterior horizontal rotating path later part.

     

Statistics for the analysis of tenderness score summation in patient with craniomandibular disorders

Digital palpation has been used to evaluate patients with craniomandibular disorders. Tendemess at each site is classified on a 0 to 3 scale and evaluated as total summation. Tendernes were ranked on the scale. Nonparametric statistics were applied to analyze these data. 34 kind 64 sites makes 192 steps in total summation. Increase of step yielded similer results in parametric and nonparametric statistics. The purpose of this study is to clarify the difference in results between nonparametric and parametric statistics. 100 female CMD patient data were used to make group of 13, 25, 50 and 100 subject group. 16 kind 30 sites, 23 kind 44 sites and 34 kind 64 sites were anlysed as summation. The Wilcoxon test and t-test were used to analyse before and after treatment data. The Spearman’s correlation coefficient and Pearson’s correlation coefficient were analyzed. In the probability, nonparametric statistics always showed more conservative result than parametric statistics. Discrepancy between nonparametric and parametric statistics decreased with an increase of the number of subjects. With 50 subjects, the maximum discrepancy was 0.0011. Discrepancy between correlation also decreased with an increase of the number of subjects. With 50 subjects, the maximum discrepancy was 0.0095. There found very little difference if the number of subjects is more than 50.