The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders
The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders
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DOI：
10.1016/s0022-3913(03)00332-9
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发表时间：
2003-08-01
影响因子：
4.6
通讯作者：
Greco, CM
中科院分区：
文献类型：
--
作者：
Pergamalian, A;Rudy, TE;Greco, CM
问题陈述。目前尚不清楚高水平磨牙症的颞下颌关节紊乱病（TMD）患者是否比低水平磨牙症的TMD患者有更严重的TMD体征和症状以及更严重的牙齿磨损。本研究的目的是确定在TMD人群中牙齿磨损、磨牙症的功能异常口腔习惯、颞下颌关节（TMJ）疼痛和肌肉疼痛严重程度之间是否存在显著关联。根据TMD研究诊断标准（RDC/TMD），共有84例既往诊断为TMD的受试者，符合10项特定的纳入/排除标准，接受了国立牙科和颅面研究所（NIDCR）推荐的全面多轴检查和分类。使用4点量表测量下颌骨模型上10个区域的牙齿磨损面。一名校准检查员进行所有评分。在标准化治疗前问卷和牙科病史和访谈（RDC/TMD）中评估磨牙症，以表明受试者进行口腔习惯列表（包括磨牙症）的频率（0 =从不至3 =非常频繁）。使用Kappa可靠性系数（范围：-1.0至1.0）校正偶然一致性，并计算指定用于评级的10个研究中心的每个研究中心的Kappa可靠性系数。还比较了受试者的肌肉和关节疼痛。肌肉疼痛是从牙科检查结果（范围0 - 20）得出的汇总指标，根据20个预定肌肉部位触诊引起的疼痛的存在或不存在进行计算。同样，关节疼痛是通过触诊下颌骨5个不同位置的外表面和外耳道关节引起的TMJ疼痛存在或不存在的总和测量。皮尔逊积差相关被用来计算牙齿磨损的严重程度和受试者的年龄。协方差分析用于确定在控制年龄影响后，报告有磨牙症史的TMD患者的磨损面数量是否显著高于报告无磨牙症或轻微磨牙症的TMD患者。采用多因素方差分析确定是否有磨牙症病史的TMD患者在标准化检查中咀嚼肌和关节部位疼痛肌肉的数量显著更高（α = 0.05）。在受试人群中，牙齿磨损与年龄适度相关（r= 0.40，P
Statement of problem. It is unclear whether patients with temporomandibular disorders (TMD) who report high levels of bruxism have more severe signs and symptoms of TMD and more advanced tooth wear than patients with TMD who report lower levels of bruxism.Purpose. The purpose of this study was to determine whether there was a significant association between tooth wear, the parafunctional oral habit of bruxism, tcmporomandibular joint (TMJ) pain, and muscle pain severity in a TMD population.Material and methods. A total of 84 subjects previously diagnosed with TMD, according to the Research Diagnostic Criteria for TMD (RDC/TMD) and who met 10 specific inclusion/exclusion criteria underwent a thorough multiaxial examination and classification recommended by the National Institute of Dental and Craniofacial Research (NIDCR). Measurement of tooth wear facets by use of a 4-point scale were graded in 10 zones on mandibular casts. One calibrated examiner performed all scoring. Bruxism was assessed in a standardized pretreatment questionnaire and in the dental history and interview (RDC/TMD) to indicate how frequently (0 = never to 3 = very often) subjects performed a list of oral habits, which included bruxism. The Kappa reliability coefficient (range from: - 1.0 to 1.0) was used to correct for chance agreement, and was computed for each of the 10 study sites designated for rating. Subjects were also compared for muscle and joint pain. Muscle pain was a summed measure derived from the dental examination findings (range 0 to 20), calculated from the presence or absence of pain induced by palpation of 20 predetermined muscle sites. Similarly, joint pain was a summed measure of the presence or absence of pain in the TMJs induced by palpation of the joints on the outer surface and in the external auditory canal in 5 different positions of the mandible. A Pearson product-moment correlation was used to compute the summed severity of tooth wear and the subjects' age. Analysis of covariance was used to determine whether the number of wear facets was significantly higher in patients with TMD who reported a history of bruxism, compared with patients with TMD who reported no or minimal bruxism, after controlling for the effect of age. Multivariate analysis of variance was used to determine whether the number of painful muscles of mastication and joint sites on standardized examination were significantly higher in patients with TMD with a history of bruxism (alpha=.05).Results. In the population tested, tooth wear was modestly correlated with age (r=.40, P