咬合重建患者的咀嚼效率测量分析

目的:通过对咬合丧失或低位咬合患者咬合重建修复后的咀嚼效率测量分析,讨论分析咬合重建修复治疗的实验室效果.方法:从就诊患者中选取12名需行咬合重建修复者作为实验组,然后进行合理的咬合重建修复.治疗完成1个月后,对其咀嚼效率进行测量,与正常对照组之间进行比较.结果:实验组与对照组之间的咀嚼效率(P<0.01)和咀嚼次数(P<0.01)均存在统计学差别,实验组的咀嚼效率约为对照组的66.39%-86.31%,平均为75.94%;对照组咀嚼效率和咀嚼次数之间不存在线性相关关系(r= 0.1998,P >0.01).结论:咬合重建后,患者满意度较高,其咀嚼效率虽然与对照组之间存在差别,但可达对照组的66.39%-86.31%,效果较理想.咀嚼效率的高低并不完全依赖于咀嚼次数的多少,咬合重建后咀嚼次数与对照组之间的差别可能是患者的适应性所导致的结果.     

Orofacial pain in young adults and associated childhood and adulthood factors: results of the population study, Wales, United Kingdom

Abstract – Objectives: The aim of the study was to investigate the prevalence of orofacial pain (OFP) among young adults (30–31 years old) and to determine the effect of childhood and adulthood risk factors on the occurrence of OFP. Methods: Prospective cohort study to investigate dental and social effects of malocclusion and effectiveness of orthodontic treatment was conducted in Wales, United Kingdom. At 20‐year follow‐up 337 subjects aged 30–31 participated (74% from previous follow‐up aged 19–20 and 33% from the baseline) and were asked about OFP. Results: The prevalence of OFP was 23% (95% CI: 19%, 28%). Childhood factors, socio‐demographic, lifestyle, health behavior factors, history of orthodontic treatment and tooth wear were not associated with OFP. Participants with OFP were more likely to report that their teeth did not fit together properly [odds ratio (OR) = 12.4, 95% CI: 2.7–56.5) and reported previous trauma to the jaws (2.3; 1.3–4.2). Both diurnal and nocturnal teeth clenching and grinding were significantly associated with OFP (3.1; 1.4–7.1). Participants with frequent headaches had increased risk of having OFP (3.7; 1.6–8.4) while having reported 4–10 types of pain in other parts of the body other than the head, was associated with OR = 9.2 (3.7–23.0). An increased tendency to have OFP was seen in those individuals with higher levels of psychological distress (2.3; 1.4–3.9), high score on Life Event Inventory (2.6; 1.3–5.3), depressive symptoms (2.2; 1.2–4.0) and stress (2.2; 1.2–4.0). High self‐esteem associated with lower risk of OFP (0.5; 0.3–0.9). Conclusions: This study shows that OFP is frequently reported by young adults aged 30–31 and supports a multifactorial etiology with factors from many domains, including local mechanical factors, psychological and co‐morbidities. However, none of the childhood factors considered in this study were associated with OFP in adulthood.     

Reduced corticostriatal functional connectivity in temporomandibular disorders

Although temporomandibular disorders (TMD) have been associated with abnormal gray matter volumes in cortical areas and in the striatum, the corticostriatal functional connectivity (FC) of patients with TMD has not been studied. Here, we studied 30 patients with TMD and 20 healthy controls that underwent clinical evaluations, including Helkimo indices, pain assessments, and resting‐state functional magnetic resonance imaging scans. The FCs of the striatal regions with the other brain areas were examined with a seed‐based approach. As seeds, we used the dorsal caudate, ventral caudate/nucleus accumbens, dorsal caudal putamen, and ventral rostral putamen regions. Voxel‐wise comparisons with controls revealed that the patients with TMD exhibited reduced FCs in the ventral corticostriatal circuitry, between the ventral striatum and ventral frontal cortices, including the anterior cingulate cortex and anterior insula; in the dorsal corticostriatal circuitry, between the dorsal striatum and the dorsal cortices, including the precentral gyrus and supramarginal gyrus; and also within the striatum. Additionally, we explored correlations between the reduced corticostriatal FCs and clinical measurements. These results directly supported the hypothesis that TMD is associated with reduced FCs in brain corticostriatal networks and that these reduced FCs may underlie the deficits in motor control, pain processing, and cognition in TMD. Our findings may contribute to the understanding of the etiologies and pathologies of TMD.     

The prevalence and treatment needs of symptoms and signs of temporomandibular disorders among young adult males

A temporomandibular disorder (TMD) screening history and screening examination was performed on 523 young adult males. The screening forms were similar to those TMD forms developed and formulated under the auspices of the American College of Prosthodontists. In turn, the substance of the latter forms was initially derived from the recommendations of the President's TMD Conference of the American Dental Association, with 62 eminent researchers, educators and clinicians as participants. Each subject was given a TMD self-administered screening history form to complete, formatted in a check - the block format. It included all items considered to be classic TMD symptoms. The screening examination was performed extraorally and included (i) range of jaw movement, (ii) digital palpation of selected masticatory muscles and palpation over the pre-auricular temporomandibula joint (TMJ) area and (iii) digital palpation for TMJ sounds during jaw movement. The subjects were categorized into the following four categories: 0 = no symptoms/signs, 1 = insignificant moderate symptoms and/or signs, 2 = significant moderate symptoms and/or signs, and 3 = severe symptoms and/or signs. The overall results showed that 75% of the subjects had TMD symptoms and/or signs. There were 6.9% in category 1, 51.4% in category 2, and 16.7% in category 3. It was recommended that subjects in category 2 and 3 should have a comprehensive TMD evaluation, in order to further identify the recommended need for TMD Therapy.     

Whiplash: pathophysiology, diagnosis, treatment, and prognosis

We have reviewed the literature relevant to pathophysiology, diagnosis, treatment, and prognosis of whiplash-associated disorder (WAD) since 1995 and provided a brief summary of literature pertaining to forces action on the head and neck during a motor vehicle accident. The scope of the current review is confined to the Quebec guidelines for WAD grades 1-3 but excludes grade 4 (neck complaints and fracture or dislocation). After excluding papers without scientific data and single case reports or case series with fewer than 20 patients, articles were reviewed for methodological quality. The diagnosis remains clinical. No imaging, physiological, or psychological study provides specific diagnostic criteria. In the acute period up to 2 weeks, soft collars or rest and work-leave do not shorten the duration of neck pain. Sick leave is reduced by high-dose methylprednisolone given within 8 h of injury, but confirmatory studies examining the cost-benefit relationship are needed. In the first 6 months, active as opposed to passive treatment results in improved outcomes. Specific exercise strategies have not been studied. For those with symptoms lasting more than 6 months, percutaneous radio-frequency neurotomy can provide pain relief for many months in those responding to blind local anesthetic facet blocks. Intra-articular corticosteroids are ineffective. Uncontrolled trials suggest that multimodal rehabilitation programs result in improved overall function. The overall prognosis for recovery has varied considerably across studies. Such variability is likely due to differences in case identification methods and whether outcome is assessed in terms of symptoms or the receipt of financial compensation for injury. The impact on prognosis of both collision- and patient-related factors is also reviewed.     

Pain catastrophizing in dental patients: Implications for treatment management

Background”Pain catastrophizing“ refers to an exaggerated negative mental set brought to bear during an actual or anticipated painful experience. A patient's perception of a dental care experience as catastrophic can result not only in poor satisfaction with the therapy but also in avoidance of necessary treatments, resulting in the deterioration of oral health.MethodsThe author reviewed literature regarding pain catastrophizing regarding dental treatment as well as behavioral models related to catastrophizing.ResultsPeople who catastrophize show excessive attention to pain (rumination), exaggerate the threat value of pain (magnification) and feel unable to cope with their suffering (helplessness). During dental treatments, greater pain catastrophizing is associated with increased pain, dental anxiety and negative thoughts regarding pain and dental procedures.ConclusionsIt is important that clinicians identify dental patients who catastrophize so as to plan and provide the best treatment for their needs.Practical ImplicationsTo manage the care of patients who catastrophize, the clinician can actively probe patients' pain experience, help them reappraise threat, manipulate their attention to pain and improve dentist-patient communication.     

P-glycoprotein-dependent resistance of cancer cells toward the extrinsic TRAIL apoptosis signaling pathway

The TNF-related apoptosis-inducing ligand (TRAIL or Apo2L) preferentially cause apoptosis of malignant cells in vitro and in vivo without severe toxicity. Therefore, TRAIL or agonist antibodies to the TRAIL DR4 and DR5 receptors are used in cancer therapy. However, many malignant cells are intrinsically resistant or acquire resistance to TRAIL. It has been previously proposed that the multidrug transporter P-glycoprotein (Pgp) might play a role in resistance of cells to intrinsic apoptotic pathways by interfering with components of ceramide metabolism or by modulating the electrochemical gradient across the plasma membrane. In this study we investigated whether Pgp also confers resistance toward extrinsic death ligands of the TNF family. To this end we focused our study on HeLa cells carrying a tetracycline-repressible plasmid system which shuts down Pgp expression in the presence of tetracycline. Our findings demonstrate that expression of Pgp is a significant factor conferring resistance to TRAIL administration, but not to other death ligands such as TNF-α and Fas ligand. Moreover, blocking Pgp transport activity sensitizes the malignant cells toward TRAIL. Therefore, Pgp transport function is required to confer resistance to TRAIL. Although the resistance to TRAIL-induced apoptosis is Pgp specific, TRAIL itself is not a direct substrate of Pgp. Pgp expression has no effect on the level of the TRAIL receptors DR4 and DR5. These findings might have clinical implications since the combination of TRAIL therapy with administration of Pgp modulators might sensitize TRAIL resistant tumors.     

DC/TMD推荐心理量表在颞下颌关节紊乱病诊疗中的应用

目的: 采用新版DC/TMD推荐的心理量表,评估颞下颌关节紊乱病（temporomandibular disorders, TMD）患者焦虑、抑郁及躯体症状等心理状况,探讨新版量表作为TMD心理轴诊断依据的临床意义。方法: 选择100例TMD初诊患者作为实验组,100例无TMD症状的普通门诊患者作为对照组。收集2组患者的一般信息,包括年龄、性别、受教育程度、个人收入等。采用广泛性焦虑症量表（GAD-7）、抑郁症状量表（PHQ-9）和健康问卷量表15（PHQ-15）对患者心理因素进行评估。采用SPSS 20.0软件包对数据进行统计学分析。结果: <30岁组和30~50岁组TMD发病率显著高于50岁以上年龄组（P<0.05）。实验组高学历者比例显著高于对照组（P<0.05）,而收入水平不是罹患TMD的危险因素（P=0.642）。实验组焦虑发生率与平均得分显著高于对照组（P<0.05）,而两组间抑郁和躯体症状得分无统计学差异（P>0.05）。疼痛性TMD患者的焦虑和抑郁程度显著高于关节疾病患者（P<0.05）,而两组间躯体症状无显著差异（P>0.05）。结论: 性别（女）、年龄（<50岁）和高学历（本科及以上）是罹患TMD的高危因素,而与收入水平无关。TMD患者的焦虑发生率和评分均高于普通口腔门诊患者,但抑郁和躯体症状与普通患者的发生率无显著差异。     

下颌骨不对称发育的全颌曲面断层片分析

目的利用口腔全颌曲面断层片测量分析发育正常的、发育性下颌偏斜畸形患者下颌骨硬组织的特征性变化。方法选择成人颞颌关节病变患者78例,正常无颞颌关节病患者115例,比较颞颌关节病变患者、正常无颞颌关节病患者的左右两侧在垂直向上线距、角度的差异。结果颞颌关节病的下颌骨双侧在垂直方向上的线距测量和角度测量均出现明显的不对称,髁状突前后径、下颌骨升支高度、髁状突至下颌平面高度、下颌角点成角、髁突顶点成角双侧比较差异有统计学意义（P〈0．05）;正常无颞颌关节病变的双侧对应比较差异均无统计学意义（P〉0．05）。结论下颌骨不对称发育是引起颞颌关节病变的一个重要因素,应予以注意。