Sipilä Kirsi, Zitting Paavo, Siira Pertti, Laukkanen Päivi, Järvelin Marjo-Riita, Oikarinen Kyösti S, Raustia Aune M
Dept. of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Oulu, Finland.
Cranio. 2002 Jul;20(3):158-64. doi: 10.1080/08869634.2002.11746206.
The etiology of facial pain is multifactorial. Based on the results of a questionnaire included in the study of the 1966 Northern Finland Birth Cohort, performed in 1997-98, we found an association of facial pain with subjective symptoms of temporomandibular disorders (TMD), neck pain and with occlusal factors reported by 5,696 subjects. The aim of the present study was to examine these associations clinically. In the year 2000, a new inquiry was sent to the following subjects living in Oulu: 1. all subjects who had reported facial pain in the former questionnaire (n=162) (case group); and 2. to a randomly selected group of nonpain controls (n=200), group matched for gender. Those who reported willingness to participate were invited to a clinical examination. Finally, the total number of subjects was 104, including 52 (10 men, 42 women) cases and 52 (10 men, 42 women) controls. Anamnestic data were collected, and clinical stomatognathic and musculoskeletal examinations were performed, both the clinicians and the subjects being unaware of the case-control status. Anamnestically, stress was the most often reported provoking factor for facial pain. Facial pain associated significantly with reported TMD symptoms and allergies. Based on clinical findings, most of the cases were classified in the myogenous subgroup of TMD. The risk for facial pain was six-fold in subjects with clinically assessed TMD, defined as moderate (DiII) or severe (DiIII) by Helkimo's clinical dysfunction index, almost six-fold in subjects with protrusion interferences and approximately three-fold in subjects with clinically assessed tenderness of distinct fibromyalgia (FM) points in the neck. According to the adjusted logistic regression analyses, TMD had the strongest influence on facial pain, followed by protrusion interferences, anamnestically reported allergies and "other headaches". The present study shows that as well as being connected with TMD, facial pain is associated with pain and muscle tenderness in the neck area.
面部疼痛的病因是多因素的。基于1997 - 1998年对1966年芬兰北部出生队列研究中所包含问卷的结果，我们在5696名受试者中发现面部疼痛与颞下颌关节紊乱症（TMD）的主观症状、颈部疼痛以及咬合因素有关。本研究的目的是从临床角度检验这些关联。2000年，向居住在奥卢的以下受试者发出了一份新的调查问卷：1. 所有在前一份问卷中报告有面部疼痛的受试者（n = 162）（病例组）；2. 一组随机选择的无疼痛对照组（n = 200），按性别匹配。那些表示愿意参与的受试者被邀请参加临床检查。最终，受试者总数为104人，包括52例（10名男性，42名女性）病例和52例（10名男性，42名女性）对照。收集了既往病史数据，并进行了口腔颌面部和肌肉骨骼的临床检查，临床医生和受试者均不知道病例对照状态。在既往病史方面，压力是最常报告的面部疼痛诱发因素。面部疼痛与报告的TMD症状和过敏显著相关。基于临床检查结果，大多数病例被归类为TMD的肌源性亚组。根据赫尔基莫临床功能指数被评定为中度（DiII）或重度（DiIII）的临床评估为TMD的受试者中，面部疼痛风险是六倍，有前伸干扰的受试者中面部疼痛风险几乎是六倍，颈部有明显纤维肌痛（FM）点临床评估压痛的受试者中面部疼痛风险约为三倍。根据校正后的逻辑回归分析，TMD对面部疼痛的影响最强，其次是前伸干扰、既往报告的过敏和“其他头痛”。本研究表明，面部疼痛除了与TMD有关外，还与颈部区域的疼痛和肌肉压痛有关。
