Temporomandibular Joint Disorders

颞下颌关节紊乱病
  • 文章类型: Journal Article
    如何引用这篇文章:VlasaA.探索睡眠质量与颞下颌关节紊乱病之间的联系。JContempDentPract2024;25(4):293-294。关键词:睡眠质量,颞下颌关节紊乱病,颞下颌关节。
    How to cite this article: Vlasa A. Exploring the Link between Sleep Quality and Temporomandibular Disorders. J Contemp Dent Pract 2024;25(4):293-294. Keywords: Sleep quality, Temporomandibular disorders, Temporomandibular joint.
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  • 文章类型: Journal Article
    目的:关于颞下颌关节紊乱病(TMD)患者外周肌氧合和咀嚼肌压力痛阈值(PPT)变化的研究是有限的。这项研究的目的是比较咬肌周围氧合的变化;不同类型TMD的个体的咬肌和颞肌的PPT以及相关的周围肌氧合和咬肌的PPT。
    方法:涉及116名参与者的横断面研究分为三组:肌肉组(MG,n=32),联合组(JG,n=30)和肌肉关节组(MJG,n=54)。个人年龄26.97±6.93,68.97%为女性,包括31,03%的男性。所有参与者都使用颞下颌疾病诊断标准进行评估,用于外周肌肉氧合的近红外光谱(NIRS)和用于PPT的压力计。
    结果:各组间咬肌的氧合无差异。在咬肌,PPT与MG(rho=0.365)和JG(rho=0.317)的组织饱和指数变化之间呈弱正相关。此外,MJG表达的PPT低于JG(p=0.004),证明MJG的肌肉疼痛更大。
    结论:MJG的咬肌PPT较低。尽管PPT取决于TMD的类型,PPT与氧合的相关性较弱。所有评估的TMD组(MG,JG,MJG)显示咬肌的血液动力学相似性。
    结论:了解咀嚼肌的疼痛阈值和血流动力学行为有助于对TMD进行更自信的理疗评估,作为谨慎和个性化干预的基础。
    OBJECTIVE: Studies exploring variations in peripheral muscle oxygenation and pressure pain thresholds (PPT) of masticatory muscles in individuals with Temporomandibular Disorders (TMDs) are limited. The purpose of this study was to compare variations in peripheral oxygenation of the masseter muscle; PPT of the masseter and temporal muscles and correlate peripheral muscle oxygenation and PPT of the masseter muscle in individuals with different types of TMDs.
    METHODS: Cross-sectional study involving 116 participants classified into three groups: muscle group (MG, n = 32), joint group (JG, n = 30) and muscle-joint group (MJG, n = 54). Individuals aged 26.97 ± 6.93, 68.97% female, 31,03% males were included. All participants were evaluated using the Diagnostic Criteria for Temporomandibular Disorders, Near-infrared spectroscopy (NIRS) for peripheral muscle oxygenation and pressure algometer for PPT.
    RESULTS: There was no difference in masseter muscle oxygenation among groups. In the masseter muscle, a weakly positive correlation was observed between PPT and variation in tissue saturation index in the MG (rho = 0.365) and JG (rho = 0.317). In addition, the MJG expressed lower PPT (p = 0.004) than JG, demonstrating that MJG had more pain in this muscle.
    CONCLUSIONS: MJG have lower PPT in the masseter muscle. Although the PPT is dependent on the type of TMDs, the correlation between PPT and oxygenation is weak. All TMDs groups evaluated (MG, JG, MJG) showed hemodynamic similarities of the masseter muscle.
    CONCLUSIONS: Understanding pain thresholds and the hemodynamic behavior of the masticatory muscles contributes to a more assertive physiotherapeutic assessment in TMDs, serving as a basis for careful and individualized interventions.
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  • 文章类型: Journal Article
    目的:颞下颌关节紊乱病(TMD)包括涉及下颌关节(颞下颌关节)及其相关解剖结构的疾病。TMD涉及的复杂性主要是由于其广泛的条件,临床体征和症状变异性,和多因素病因。考虑到上述情况,进行本研究是为了帮助了解印度牙医在新专业“口面部疼痛”背景下对TMD的普遍知识和认识。
    方法:Questinnaire研究和综述。
    方法:问卷是使用全国范围内的门户网站在印度牙医中分发的。牙医被邀请参加,明确指出问卷的意图和目的是记录印度牙医对颞下颌关节紊乱病的现有知识和认识。问卷分为三个部分:发病机理,诊断,和管理TMD。使用Likert三点量表记录问题(1=同意;2=不同意;3=不知道)。310名牙医参加了调查,其中105名是普通牙医(BDS[牙科外科学士]毕业生),205名是经过专业培训的牙医(MDS[牙科外科硕士]毕业生)。
    方法:从研究参与者获得的结果用于计算百分比和频率,随后根据毕业生类型和临床经验制作表格.记录从所有三个部分获得的值,并使用Pearson卡方检验对反应进行分析,统计学意义保持在P<0.05。
    结果:研究结果显示,只有58.1%的普通牙医和46.8%的专家对处理颞下颌关节紊乱病患者有信心。夹板疗法是普通牙医的首选治疗方式,而经过专科训练的牙医更喜欢咬合康复。
    结论:当前调查的结果表明,印度牙医在牙科学校的所有三个部分都缺乏足够的培训,并且在诊断和治疗TMD方面面临困难。
    OBJECTIVE: Temporomandibular disorders (TMD) comprise ailments involving the jaw joint (temporomandibular joint) and its associated anatomical structures. The complexity involved in TMD is primarily due to its broad spectrum of conditions, clinical signs and symptoms variability, and multifactorial etiology. Considering the above, the present study was performed to help understand the prevailing knowledge and awareness of TMD among Indian dentists in the context of the new specialty \"orofacial pain\".
    METHODS: Questinnaire study and review.
    METHODS: The questionnaire was distributed using a web-based portal nationwide among Indian dentists. Dentists were invited to participate, clearly stating that the intent and purpose of the questionnaire was to record the existing knowledge and awareness concerning temporomandibular disorders among Indian dentists. The questionnaire was segregated into three sections: pathogenesis, diagnosis, and management of TMDs. The questions were recorded using a Likert three-point scale (1=agree; 2=disagree; 3=not aware). 310 dentists participated in the survey, among which 105 were general dentists (BDS [Bachelor of Dental Surgery] graduates), and 205 were dentists with specialist training (MDS [Masters of Dental Surgery] graduates).
    METHODS: The results obtained from the study participants was used to calculate the percentage and frequency, following which tabulations were made based on graduate type and clinical experience. The values obtained from all three sections were recorded, and the responses were analysed using Pearson\'s Chi-Square test with statistical significance kept at P < 0.05.
    RESULTS: Results of the study disclosed that only 58.1% of general dentists and 46.8% of specialists were confident in handling temporomandibular disorder patients. Splint therapy was the preferred treatment modality for general dentists, whereas dentists with specialist training preferred occlusal rehabilitation.
    CONCLUSIONS: The results of the current survey indicate that Indian dentists lack sufficient training in dental schools on all three sections and face difficulty diagnosing and treating TMDs.
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  • 文章类型: Journal Article
    幼年特发性关节炎(JIA)伴颞下颌关节(TMJ)受累后的牙面畸形与功能有关,美学,和心理社会损害。矫正手术治疗包括正颌手术(OS)的组合。这项研究的目的是评估口面部症状,功能和美学地位,OS包括下颌骨牵张成骨(MDO)后的稳定性。对32例TMJJIA和牙颌面畸形患者进行了前瞻性研究,这些患者接受了MDO作为唯一的手术或联合双侧矢状位劈开截骨术,LeFortI,和/或2003年至2018年之间的Genioplast。分析了术前,术后和长期(平均4年)进行的临床检查和头状图的数据。患者的口面部症状未发生改变(均P>0.05),短期TMJ功能损害(所有P<0.001),SNB角度的长期形态学改善(P<0.001),前面部高度(P<0.001),下颌长度(P=0.049),超喷(P<0.001和P=0.005),后面部对称性(P=0.046)。MDO作为唯一的手术或辅助OS在下颌前移方面改善了牙面形态,前面部高度,后面部对称性,和切缘关系,没有TMJ功能或口面部症状的长期恶化。
    Dentofacial deformity following juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement is associated with functional, aesthetic, and psychosocial impairment. Corrective surgical treatment includes combinations of orthognathic surgeries (OS). The aims of this study were to assess orofacial symptoms, functional and aesthetic status, and stability after OS including mandibular distraction osteogenesis (MDO). A prospective study was conducted of 32 patients with JIA of the TMJ and dentofacial deformities who underwent MDO as the only surgery or in combination with bilateral sagittal split osteotomy, Le Fort I, and/or genioplastybetween 2003 and 2018. Data from clinical examinations and cephalograms performed pre- and postoperative and at long-term (mean 4 years) were analysed. Patients experienced unchanged orofacial symptoms (all P > 0.05), short-term TMJ functional impairment (all P < 0.001), and long-term morphological improvements in SNB angle (P < 0.001), anterior facial height (P < 0.001), mandibular length (P = 0.049), overjet (P < 0.001 and P = 0.005), and posterior facial symmetry (P = 0.046). MDO as the only surgery or with secondary adjunctive OS improved dentofacial morphology in terms of mandibular advancement, anterior facial height, posterior facial symmetry, and incisal relationships without long-term deterioration in TMJ function or orofacial symptoms.
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  • 文章类型: Journal Article
    随着颞下颌关节紊乱病(TMDs)在初级和二级护理环境中变得越来越普遍,成功的管理在这两个领域都面临着越来越大的挑战。作者旨在探讨TMD管理的困境,因为患者从初级护理到二级护理,并提供教育工具来支持从业者管理这个复杂的患者队列。以及概述TMD管理策略交付的替代解决方案。
    As temporomandibular disorders (TMDs) become ever more prevalent in both primary and secondary care settings, successful management is increasingly challenging in both sectors. The authors aim to explore the dilemma of TMD management as the patient journeys through from primary to secondary care and offer educational tools to support practitioners in managing this complex patient cohort, as well as outlining alternative solutions for the delivery of TMD management strategies.
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  • 文章类型: Journal Article
    颞下颌关节功能障碍(TMD)是一种常见病,患者向牙医和医生报告症状。TMD的病因可能是多因素的,咬合,功能和心理因素都可能在不同的个体中发挥不同程度的作用。牙医的个人账户,患有TMD超过40年,记录他们对不同治疗的经验,并得出结论,支持患者“学会生活”与TMD是管理的关键。
    Temporomandibular joint dysfunction (TMD) is a common condition, with patients reporting symptoms to both dentists and doctors. The aetiology of TMD is likely to be multifactorial, with occlusal, parafunctional and psychological factors all potentially playing a part to varying degrees in different individuals. A personal account by a dentist, suffering from TMD for over 40 years, chronicles their experience of different treatments and concludes that supporting a patient to \'learn to live\' with TMD is pivotal to management.
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  • 文章类型: Case Reports
    痛风是一种代谢紊乱,导致血清尿酸水平升高和尿酸盐晶体在关节中沉积。该疾病通常局限于关节间隙,并导致疼痛和颌骨开放的限制。该病例描述了一名45岁的女性患者,主要主诉为“左颞肌区域偶尔疼痛”。该病例在物理和影像学检查结果后发现了颞下颌关节(TMJ)的痛风表现。痛风在TMJ中的表现是不寻常的表现,英语文献中的一些报道解决了这个问题。TMJ痛风由于罕见,应作为关节疾病的鉴别诊断。临床医生在面部疼痛的鉴别诊断中可能会忽略涉及TMJ的痛风,即使患者已在其他关节中诊断为痛风。
    UNASSIGNED: Gout is a metabolic disorder that leads to elevated serum uric acid levels and deposition of urate crystals in the joints. The disease is usually confined to the joint space and leads to pain and limitation of jaw opening. The case describes a 45-year-old female patient with a chief complaint of \'occasional pain in the left temporal muscle region\'. The case disclosed a gout manifestation in the temporomandibular joint (TMJ) after physical and radiographic findings. Gout manifestation in the TMJ is an unusual presentation and a few reports in the English literature address the subject. Gout in the TMJ should be included as a differential diagnosis for joint disorders because of its rarity. A clinician may overlook gout involving the TMJ in the differential diagnosis of facial pain even when the patient has received a diagnosis of gout in other joints.
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  • 文章类型: Journal Article
    背景:颞下颌疾病诊断标准(DC/TMD)是本科牙科课程的一部分。如今,在线教学在牙科中也变得很普遍。
    目的:比较本科生对传统学习和在线学习的DC/TMD轴I的自我评估能力和满意度,并评估在线教学的可能收益。
    方法:2018年三年级本科牙科学生(传统学习,第1组,n=43/50)和2019年(在线学习,第2组,n=34/50)在奥卢大学,芬兰以10分量表评估了他们对学习DC/TMD临床检查和诊断的自我评估能力和满意度。此外,参加在线课程的人回答了两个开放式问题;第2组(n=50)和2019年和2020年来自东芬兰大学的另一组(n=75,第3组).共有105/125名学生(84%)做出了回应。内容分析用于开放式响应。
    结果:在线课程报告了在测量方面的自我评估能力显着提高(p=0.004),确定转诊疼痛(p=0.043)和诊断说明(p=0.017),以及更高的测量自我评估满意度(p=0.046).根据内容分析,在线教学的基本收获是高效学习,视频和练习,以及对自己时间表的可调性。
    结论:在线学习课程可以被认为是传统学习DC/TMD协议的良好选择。
    BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is part of the undergraduate dental curriculum. Online teaching has nowadays become common also in dentistry.
    OBJECTIVE: To compare undergraduate students\' self-assessed ability and satisfaction with learning DC/TMD Axis I between traditional and online learning and to evaluate the possible gains of online teaching.
    METHODS: Third-year undergraduate dental students in 2018 (traditional learning, Group 1, n = 43/50) and in 2019 (online learning, Group 2, n = 34/50) at the University of Oulu, Finland evaluated their self-assessed ability and satisfaction with learning DC/TMD clinical examination and diagnostics on a 10-point scale. Additionally, those participating in online courses answered to two open-ended questions; Group 2 (n = 50) and another group from the University of Eastern Finland in 2019 and 2020 (n = 75, Group 3). Total of 105/125 students (84%) responded. Content analysis was used to open-ended responses.
    RESULTS: The online course reported significantly higher self-assessed ability in measurements (p = 0.004), identifying referred pain (p = 0.043) and statement for the diagnostics (p = 0.017) and also higher self-assessed satisfaction in measurements (p = 0.046). According to the content analysis, essential gains of online teaching were efficient learning, videos and exercises, and adjustability to own timetable.
    CONCLUSIONS: The online learning course can be considered as a good option for traditional learning of the DC/TMD protocol.
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  • 文章类型: Journal Article
    背景和目的:颞下颌关节紊乱或功能障碍(TMD)包括一系列影响颞下颌关节(TMJ)的复杂疾病,咀嚼肌肉,牙齿,和/或它们的支持组织。压力是作为TMD预测因子研究的最相关因素之一。目的是了解考试期间和考试前压力对大学生TMJ状态和唾液皮质醇的影响。材料和方法:本研究是非实验性的,采用纵向,分析,观察性队列设计。研究人群包括在AlfonsoXElSabio大学(马德里,西班牙)。数据是在两个不同的学术时期收集的:第一阶段的特点是学术压力低,没有考试,第二阶段恰逢期末课程考试的高学术压力。收集的结果包括社会人口统计数据,TMJ状态评估(丰塞卡指数),肌肉评估的评估(咬肌,上斜方肌,和胸锁乳突肌)使用MOXY监测器(肌肉氧合)和Neurotrac®(表面肌电图,sEMG),感知压力评估(PSS-14),和唾液皮质醇的测量(酶免疫测定与Elisa)。统计学分析的置信水平为95%(p≤0.05),具有渐近或双侧显著性。结果:在两个不同的测量期间对70名学生进行了分析。根据丰塞卡指数,最初,37.14%的被分析学生表现出轻度的TMD,17.14%中度TMD,45.72%无TMD。总的来说,压力随着年龄的增长而增加,并且与女性有关,最大张口随着年龄的增长而减少,氧饱和度随着年龄和学业压力的增加而降低,肌红蛋白浓度与年龄有关。此外,在较高的学业压力下,肌肉收缩减少,并随着年龄的增长而增加。对女人来说,年龄是患TMD的危险因素,压力恶化了两性从有TMD到没有TMD的过渡。结论:学业压力影响TMJ状态和肌肉结果,如氧饱和度,肌红蛋白浓度,肌肉收缩,虽然还需要更多的研究。
    Background and Objectives: Temporomandibular disorders or dysfunction (TMDs) encompass a range of complex conditions that impact the temporomandibular joint (TMJ), chewing muscles, teeth, and/or their supporting tissues. Stress is one of the most associated factors studied as a TMD predictor. The aim is to figure out the influence of stress on TMJ status and salivary cortisol in university students during and before exams. Materials and Methods: The study was non-experimental, employing a longitudinal, analytical, observational cohort design. The study population consisted of students enrolled in the physiotherapy degree program at the Alfonso X El Sabio University (Madrid, Spain). Data were collected during two distinct academic periods: the first period was characterized by low academic stress and no exams, and the second period coincided with the high academic stress of final course exams. The collected results included sociodemographic data, assessment of TMJ status (Fonseca Index), evaluation of muscle evaluation (masseter, upper trapezius, and sternocleidomastoid) using a MOXY Monitor (muscle oxygenation) and Neurotrac® (surface EMG, sEMG), assessment of perceived stress (PSS-14), and measurement of salivary cortisol (enzyme immunoassay with Elisa). The statistical analysis was conducted with a confidence level of 95% (p ≤ 0.05) and asymptotic or bilateral significance. Results: 70 students were analyzed during two different measurement periods. According to the Fonseca Index, initially, 37.14% of the analyzed students showed mild TMDs, 17.14% moderate TMDs, and 45.72% showed no TMDs. In general terms, stress increased with age and is related to female sex, maximum mouth opening decreased with age, oxygen saturation decreased with age and academic stress, and myoglobin concentration was related to age. Furthermore, muscle contraction decreased during higher academic stress and increased with age. For women, age was a risk factor for suffering from TMDs, and stress worsened the transition from having TMDs to having no TMDs in both sexes. Conclusions: Academic stress influences TMJ status and muscle outcomes such as oxygen saturation, myoglobin concentration, and muscle contraction, although more research is needed.
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  • 文章类型: Journal Article
    颞下颌关节紊乱病包括影响咀嚼系统的各种病症,影响它的结构,函数,或生理学。临床医生在治疗这类疾病时面临着一系列复杂的治疗选择,强调评估当前证据以指导患者护理决策的重要性。本文的主要目的是对治疗颞下颌关节紊乱病(TMDs)的可用治疗方法进行范围审查。在Scopus上进行了广泛的文献搜索,Pubmed,Embase,和WebofScience。考虑了过去5年发表的系统评价。在确定的2183种出版物中,109项研究纳入本综述。其中,39篇文章聚焦于非侵入性方法,当120人深入研究微创方法时,15探索了手术方法。非侵入性或保守的方法,如认知行为疗法,物理治疗,和针灸提供有效的疼痛管理和TMD的功能改善。新兴的治疗方法为治疗这些疾病提供了有希望的替代方案。手术应保留用于严重病例,保守疗法与侵入性手术结合使用,以获得最佳患者预后。
    Temporomandibular disorders include various conditions that impact the masticatory system, affecting its structure, function, or physiology. Clinicians face a complex array of therapeutic options when treating this group of diseases, emphasizing the importance of evaluating the current evidence to guide decisions in patient care. The main objective of this article is to conduct a scoping review on the available treatment approaches to manage temporomandibular disorders (TMDs). An extensive search of the literature was performed on Scopus, Pubmed, Embase, and Web of Science. Systematic reviews published in the last 5 years were considered. Out of the 2183 publications identified, 109 studies were included in this review. Among them, 39 articles focused on the non-invasive approach, while 120 delved into the minimally invasive approach, and 15 explored the surgical approach. Non-invasive or conservative approaches like cognitive-behavioral therapy, physical therapy, and acupuncture offer effective pain management and functional improvements in TMDs. Emerging treatments offer promising alternatives for treating these disorders. Surgery should be reserved for severe cases, with conservative therapies used in conjunction with invasive procedures for optimal patient outcomes.
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