The Database with Expert System for Differential and Etiological Diagnosis of CMD

为了使颅下颌骨疾病的治疗取得成功，必须建立正确的鉴别诊断和病因学诊断。在本项目中，我们打算基于CMD患者的临床体征/症状和因素数据库，构建CMD诊断专家系统。我们设计了CMD数据库，输入了约400例患者的数据。为了量化CMD的临床特征，应用该系统。因此，人们认识到，一种普遍的症状模式具有规律性，例如，开口疼痛和开口有限之间存在很强的关系。此外，我们也认识到临床特征随因素的不同而不同。即在有情绪压力的患者中，主要症状较少，相关症状显著普遍。垂直尺寸低、颞下颌关节区、枕肌触诊痛及相关症状均显著高于对照组。开咬患者颞下颌关节区疼痛明显，咬肌触诊疼痛发生率较低。咬合干扰、颞下颌关节杂音、二腹肌后触诊痛明显多见，开口受限少见。这些患者的咬合接触模式表现为接触点小，左右弓分布不均匀。此外，单侧临床体征和症状的识别率和同侧咬合干扰的发生率均显著。特别是，大多数的咬合干扰被发现在后牙的咬合面，引导下颌运动到突出和中外侧位置。这些结果表明，利用数据库和专家系统对CMD进行鉴别诊断和病因诊断是可行的。因此，我们打算揭示CMD的固有特征，并改进这一系统。少

To lead the successful outcome of the treatment in craniomandibular disorders, it is essential to establish proper differential and etiological diagnosis. In this project we intend to construct an expert system for diagnosis in CMD, based on a database regarding the clinical signs/symptoms and the factors of CMD patients. We designed a database for CMD and the data of about 400 patients were entered. In order to quantify the clinical characteristics of CMD using this system. As the result, it was recognized that a prevalence pattern of symptoms have a regularity, for example, there were a strong relationships between opening pain and limited opening. Also, it was recognized that the clinical characteristics differ with the factors. That is, in patients with emotional stress, major symptom was less prevalent and associated symptom was significantly prevalent. Patients with low vertical dimension, palpation pain on TMJ region, occipital muscles and associated symptom were significantly p … More revalent. Patients with Open-bite, pain on TMJ region was significantly prevalent and palpation pain on masseter muscle was less prevalent. Patients with occlusal interference, TMJ noise and palpation pain of posterior digastric muscle were significantly prevalent while limited opening was less prevalent. The occlusal contact pattern of these patients had shown small contact points and uneven distribution between right and left arches. Furthermore, the rate of clinical signs and symptoms were recognized on the unilateral and that of occlusal interferences were observed in the same side were significant. Especially, most occlusal interferences were detected on the occlusal facets of the posterior teeth that guides mandibular movement to protrude and mediolateral position.These results indicate that a differential as well as etiological diagnosis for CMD are feasible by the use of database and expert system. We therefore intend to reveal inherent characteristics of CMD, and to improve this system. Less