Kamisaka M, Yatani H, Kuboki T, Matsuka Y, Minakuchi H
Department of Fixed Prosthodontics, Okayama University Dental School, 2-5-1 Shikata, Okayama 700-8525, Japan.
J Orofac Pain. 2000 Summer;14(3):224-32.
To investigate the natural course of symptoms of temporomandibular disorders (TMD) in a non-patient population and to estimate the strength of the relationship between several hypothesized risk factors and precipitation and perpetuation of the symptoms.
A total of 672 randomly selected citizens of Okayama City was requested to answer the same self-administered questionnaire that they had answered 4 years earlier. The mailed questionnaire failed to reach 58 subjects at the second survey, and 367 of the remaining subjects (59.8%) responded. The fluctuation of TMD symptoms was assessed by comparison of 6 pairs of answers for questions regarding temporomandibular joint (TMJ) pain, limitation of mouth opening, TMJ noise, headache, neck pain, and shoulder stiffness. Six factors (age under 40, female, clenching habit, history of extrinsic trauma, sleep disturbance, and family history of TMD) were tested for their relative risk in precipitating and perpetuating each TMD symptom by the use of its confidence interval to define significance.
The incidence of TMD symptoms ranged from 6.1% (TMJ pain) to 12.9% (TMJ noise). More than half of the subjects who had reported TMJ and neck pain at the initial survey no longer reported these symptoms at the second survey, whereas TMJ noise and shoulder stiffness remained in more than 70% of the subjects. Individuals under 40 years old had a 3.3:1 increased risk of precipitating TMJ noise (P < 0.01), individuals with a history of extrinsic trauma had a 2.85:1 increased risk of precipitating limited mouth opening (P < 0.01), and females had a 2.81:1 increased risk of perpetuating TMJ pain (P < 0.01).
The possible etiologic significance of these factors in TMD should be validated by future research.
调查非患者人群颞下颌关节紊乱病（TMD）症状的自然病程，并评估几种假设的危险因素与症状的诱发和持续之间关系的强度。
共邀请672名随机抽取的冈山市市民回答他们4年前曾回答过的相同的自填式问卷。在第二次调查时，邮寄的问卷未能送达58名受试者，其余受试者中有367名（59.8%）做出了回应。通过比较关于颞下颌关节（TMJ）疼痛、张口受限、TMJ弹响、头痛、颈部疼痛和肩部僵硬的6对问题答案，评估TMD症状的波动情况。通过使用其置信区间来定义显著性，测试了六个因素（40岁以下、女性、紧咬牙习惯、外部创伤史、睡眠障碍和TMD家族史）在诱发和使每种TMD症状持续存在方面的相对风险。
TMD症状的发生率从6.1%（TMJ疼痛）到12.9%（TMJ弹响）不等。在初次调查中报告有TMJ和颈部疼痛的受试者中，超过一半在第二次调查时不再报告这些症状，而TMJ弹响和肩部僵硬在超过70%的受试者中仍然存在。40岁以下的个体诱发TMJ弹响的风险增加了3.3倍（P<0.01），有外部创伤史的个体诱发张口受限的风险增加了2.85倍（P<0.01），女性使TMJ疼痛持续存在的风险增加了2.81倍（P<0.01）。
这些因素在TMD中可能的病因学意义应通过未来的研究来验证。
