少年儿童颞下颌关节紊乱病的临床分析

目的探讨颞下颌关节紊乱病（以下简称TMD）少年儿童的发病情况及其对生长发育的影响。方法统计分析我院诊治的200例少年儿童颞下颌关节紊乱病患者的临床资料，就其病因、发病隋况等问题进行了初步的分析。结果TMD病因复杂，少年儿童TMD者大部分为早期，弹响是关节功能紊乱、结构紊乱和器质破坏的外在表现。结论对少年儿童TMD患者的早期防治是必要的，TMD是有可能治愈和控制的。     

正畸治疗与颞下颌关节症状的相关研究

目的：探讨正畸治疗和颞下颌关节紊乱病（TMD）的关系。方法：设计正畸组、错[牙合]组和正常组的调查表，用Visual Foxpro6．0建立相应的数据库，对173例已正畸治疗者、95例有错[牙合]畸形但未治疗者和32例正常对照进行TMD症状、体征及相关情况的问卷调查和专科检查，所得结果用基于Helkimo指数改良设计的数据库进行分析，采用SPSS10．0软件包进行成组设计两样本比较的秩和检验。结果：正畸组和错[牙合]组在主诉症状指数、临床症状指数和咬合指数的分布上存在显著差异（P〈0．001）；正畸组和正常组在主诉症状指数和临床症状指数的分布上有显著差异（P〈0．001），但在咬合指数的分布上无显著性差异（P〉0．05）。结论：正畸治疗后患者在一定时期内易出现颞下颌关节紊乱病的症状和体征。     

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.     

Impact of prolotherapy in temporomandibular joint disorder: a quality of life assessment

Chronic pain and functional impairment associated with temporomandibular joint (TMJ) disorders (TMD) considerably reduce oral health-related quality of life (OHRQoL). In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of QoL using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 – 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks) using the method suggested by Hemwall-Hackett. They were asked to answer the OHIP-14 questionnaire before and two years after prolotherapy. Seven domains of OHRQoL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domain scores and total OHIP-14 scores were compared using inferential statistics (chi squared and Wilcoxon signed rank tests). Prolotherapy was effective over time, as all the domains’ mean scores decreased considerably after treatment. The total mean score before prolotherapy was 21.20, which was extensively reduced to 13.08 after prolotherapy (p=0.001). There was statistically significant improvement in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap (p≤0.005 in all cases). We concluded that prolotherapy has a promising role in the improvement of OHRQoL of patients with TMD, and its beneficial effects persist at least two years after treatment.     

Imaging temporomandibular disorders: Reliability of a novel MRI-based scoring system

The aim of this study was to assess the inter- and intrarater reliability of a recently proposed scoring system for temporomandibular disorders (TMD), based upon radiological findings from magnetic resonance imaging (MRI).Patients with clinically suspected uni- or bilateral TMD, and subsequently conducted MRI examination of both temporomandibular joints, were included in this study. MRI data were independently evaluated by two experienced radiologists according to the DLJ scoring system proposed by Wurm et al., which includes assessment of the following categories: articular disk (prefix ‘D’), direction of disk luxation (prefix ‘L’), and osseous joint alterations (prefix ‘J’).60 patients (49 female and 11 male) were eligible for analysis. No significant differences were found between both observers regarding ‘D’ and ‘L’ scores (p = 0.13 and p = 0.59, respectively). Significant differences were found for the assessment of subtle osseous changes (‘J0’ category: p = 0.041; ‘J1’ category: p = 0.018). Almost perfect intra- and interrater agreements were found for ‘D’ and ‘L’ categories (intrarater and interrater agreements for ‘D’: κ = 0.92 and κ = 0.84, respectively; intrarater and interrater agreements for ‘L’: κ = 0.93 and κ = 0.89, respectively). However, the assessment of ‘J’ categories revealed only moderate interrater agreement (κ = 0.49).The DLJ scoring system based upon MRI findings is feasible for routine clinical TMD assessment, and may help to simplify interdisciplinary communication between radiologists and clinicians.     

Absence of joint pain identifies high levels of sleep masticatory muscle activity in myofascial temporomandibular disorder

Although the development of reliable diagnostic criteria for temporomandibular disorders (TMDs) has operationalised identification of a subgroup with myofascial pain (mTMD), causal mechanisms remain elusive. This study examines masticatory muscle activity (MMA) in more homogenous research subgroups of mTMD. Data from an existing case‐control study of women were used to subcategorise mTMD cases based on joint pain with palpation to isolate muscle‐only pain (M‐pain) vs muscle and joint pain (MJ‐pain). Differences in laboratory indicators of MMA, specifically research diagnostic criteria for sleep bruxism (SB) and high background EMG activity, and other clinical and sociodemographic indicators were examined between groups. Compared to controls, the MJ‐pain subgroup did not show elevated background EMG or sleep bruxism. In contrast, the M‐pain subgroup showed significantly higher background EMG and a trend towards elevated prevalence of sleep bruxism. These results may explain why it has been difficult for studies of SB in mixed TMD and even mTMD samples to find a consistent positive association, since a positive association may be limited to mTMD without joint pain. The subcategorising of mTMD based on joint pain with palpation (ie M‐pain, MJ‐pain) appears to reveal subgroups with relatively high and low sleep masticatory muscle‐specific activity. Findings need replication in a larger study with updated mTMD diagnostic criteria, but may prove useful for understanding mechanism of pain maintenance in mTMD with and without joint pain.     

Bland-Altman法分析甲颏距离的测量的准确性

目的:观察甲颏距离(TMD)测量的准确性及男女患者之间的区别,为临床应用提供参考。方法:由具有5年以上经验的麻醉医师通过手指触摸定位的常规方法测量TMD;由另一位麻醉医师采用超声技术定位甲状软骨切迹,并测量。采用Bland-Altman法进行分析,分别计算男性患者和女性患者触摸定位法测量TMD和超声定位测量TMD的一致性系数(Cronbach α)。结果:男性患者的一致性界限(LoA)为-7.4~6.1 mm,女性患者的LoA为-22.6~14.7 mm。男性患者的Cronbach α为0.958,女性患者的Cronbach α为0.438。结论:相对于男性患者,女性触诊法测量TMD的方法其准确性不高。     

Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with arthrocentesis plus hyaluronic acid injections

This study is an open-label trial on a sample of 76 consecutive patients with temporomandibular joint (TMJ) osteoarthritis treated with a cycle of five weekly arthrocenteses plus hyaluronic acid injections. Patients had a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD Axis I Group IIIb). They underwent a cycle of five arthrocenteses with injections (1 per week) of 1 ml hyaluronic acid and four follow-up assessments after the end of the treatment (at 1 week, 1 month, 3 months, 6 months). At each appointment, several subjective and objective outcome variables were assessed to test the efficacy of the treatment protocol. Marked improvements were reported for all variables during the treatment phase. The improvements were maintained over the 6-month follow-up period. The p-value of the multivariate permutation test for the efficacy of the treatment over time (with Tippett's combination) was 0.001, and significant changes at the end of the follow-up period were detected for almost all the outcome variables. Data from this study lend further support to the usefulness of serial hyaluronic acid injections performed after arthrocentesis for the treatment of TMJ osteoarthritis and for the maintenance of improvements over a 6-month follow-up period.