Macfarlane T V, Kincey J, Worthington H V
The University Dental Hospital of Manchester, UK.
Oral Dis. 2001 Nov;7(6):321-30. doi: 10.1034/j.1601-0825.2001.00758.x.
To determine the individual and combined effects of potential risk factors in relation to the temporomandibular disorder, Pain Dysfunction Syndrome (PDS).
Case-control study.
Cases were new referrals to the temporomandibular disorder clinic of the University Dental Hospital of Manchester, diagnosed with PDS. Controls were randomly selected from 24 dental practices. Using a postal questionnaire information was collected on socio-demographic, local mechanical, psychological factors, co-morbidities and illness behaviour. The adjusted participation rate was similar in cases and controls (64%), and 131 cases and 196 controls finally participated in the study.
Compared with the controls, the cases were more likely to report that their teeth felt as though they did not fit together properly [odds ratio (OR) 8, 95% Confidence Interval (CI) 6-13] and report history of facial trauma (OR 3, 95% CI 2-6). Both diurnal and nocturnal grinding were significantly associated with PDS, and individuals who reported grinding their teeth both during the day and at night had a risk of 6; 95% CI 3-13 for PDS compared with those who did not. A history of orthodontic treatment, having any dentures, having missing teeth, use of chewing gum or biting the fingernails did not show any relationship with PDS. People who took medication for the bowels had a higher risk of PDS (OR 2, 95% CI 1-4). Participants with frequent headaches had a threefold increase in risk of having PDS (OR 3, 95% CI 2-5) while having pain in parts of the body other than the head was associated with an OR of 3 (95% CI 2-5). An increased propensity to have PDS was seen in those individuals with higher levels of psychological distress (OR 3; 95% CI 1-4 in the highest category, test for trend P < 0.001) and sleep disturbance (OR 5; 95% CI 2-94 in the highest category, test for trend P < 0.001). Aspects of illness behaviour, such as disease conviction (OR 4; 95% CI 2-9 in the highest category) and perception of illness (0.3; 95% CI 0.2-0.5) were associated with PDS. The result for the denial scale became statistically significant after adjustment for age and gender (2; 95% CI 1-3).
The current case-control study provides complementary epidemiological information on oro-facial pain (OFP) and supports a multifactorial aetiology of PDS, with factors from many domains, including local mechanical factors, psychological and co-morbidities. People with PDS were characterized by frequent headaches, history of facial trauma, teeth grinding, sleep problems, pain elsewhere in the body and high levels of psychological distress. From the results of current study and available evidence it seems inappropriate to consider PDS in isolation and future research should adopt a multidisciplinary approach to OFP.
确定与颞下颌关节紊乱症疼痛功能障碍综合征（PDS）相关的潜在风险因素的个体及综合影响。
病例对照研究。
病例为新转诊至曼彻斯特大学牙科医院颞下颌关节紊乱症诊所、被诊断为PDS的患者。对照是从24家牙科诊所中随机选取的。通过邮寄问卷收集社会人口统计学、局部机械因素、心理因素、共病及疾病行为方面的信息。病例组和对照组的调整参与率相似（64%），最终131例病例和196例对照参与了研究。
与对照组相比，病例组更有可能报告牙齿感觉好像不能正常咬合在一起[优势比（OR）8，95%置信区间（CI）6 - 13]以及有面部创伤史（OR 3，95% CI 2 - 6）。日间和夜间磨牙均与PDS显著相关，报告白天和晚上都磨牙的个体患PDS的风险为6；95% CI 3 - 13，而未磨牙者则无此风险。正畸治疗史、佩戴假牙、牙齿缺失、嚼口香糖或咬指甲与PDS均无关联。服用肠道药物的人患PDS的风险更高（OR 2，95% CI 1 - 4）。经常头痛的参与者患PDS的风险增加三倍（OR 3，95% CI 2 - 5），而身体非头部部位疼痛与PDS的关联度为OR 3（95% CI 2 - 5）。心理困扰程度较高（最高类别中OR 3；95% CI 1 - 4，趋势检验P < 0.001）和睡眠障碍（最高类别中OR 5；95% CI 2 - 94，趋势检验P < 0.001）的个体患PDS的倾向增加。疾病行为的某些方面，如疾病确信（最高类别中OR 4；95% CI 2 - 9）和疾病认知（0.3；95% CI 0.2 - 0.5）与PDS相关。在对年龄和性别进行调整后，否认量表的结果具有统计学意义（2；95% CI 1 - 3）。
当前的病例对照研究提供了关于口面部疼痛（OFP）的补充流行病学信息，并支持PDS的多因素病因学，涉及多个领域的因素，包括局部机械因素、心理因素和共病。PDS患者的特征为经常头痛、面部创伤史、磨牙、睡眠问题、身体其他部位疼痛以及心理困扰程度高。从当前研究结果和现有证据来看，孤立地考虑PDS似乎并不合适，未来的研究应采用多学科方法来研究OFP。
