Wahlund Kerstin
Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Malmö Sweden.
Swed Dent J Suppl. 2003(164):inside front cover, 2-64.
The aim of the present thesis was to investigate different aspects of temporomandibular disorders (TMD) and pain such as prevalence, diagnostics, and treatment among adolescents. The reliability of a questionnaire and the clinical examination and diagnoses according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were assessed. Overall, we found it possible to assess and diagnose TMD in adolescents in a reliable way. The prevalence of TMD pain, gender differences, and the need for treatment were investigated among 864 adolescents from a Public Dental Service clinic. Seven percent of the subjects received a pain diagnosis according to the RDC/TMD, and the prevalence was higher among girls than boys. More subjects with TMD pain reported school absence and analgesic consumption compared to controls. Approximately every second subject who reported TMD pain also perceived a need for treatment. In an evaluation of psychosocial and dental factors, the following were found to play an important role in adolescents with TMD: stress, somatic complaints, and emotional problems. Three treatment methods were compared in a randomized controlled trial: brief information only, brief information and occlusal appliance, and brief information and relaxation therapy. In the brief information and occlusal appliance group, 60%--significantly more than in the other two groups--experienced a reduction of at least 50% in TMD pain. The influence of somatic and emotional stimuli was evaluated, and we found that adolescents with TMD pain were significantly more sensitive to not only aversive somatic but also pleasant somatic stimuli compared with healthy controls. The results suggest that not only nociceptive but also cognitive processes are implicated in chronic pain states in young TMD subjects. In conclusion, TMD pain is more common in girls than in boys and affects daily life. TMD pain in adolescents can best be improved by traditional treatment with occlusal appliance combined with brief information.
本论文的目的是调查青少年颞下颌关节紊乱病（TMD）和疼痛的不同方面，如患病率、诊断和治疗。评估了一份问卷的可靠性以及根据颞下颌关节紊乱病研究诊断标准（RDC/TMD）进行的临床检查和诊断。总体而言，我们发现可以以可靠的方式评估和诊断青少年的TMD。在一家公共牙科服务诊所的864名青少年中，调查了TMD疼痛的患病率、性别差异和治疗需求。7%的受试者根据RDC/TMD获得了疼痛诊断，女孩中的患病率高于男孩。与对照组相比，更多患有TMD疼痛的受试者报告缺课和服用镇痛药。大约每第二个报告TMD疼痛的受试者也认为需要治疗。在对心理社会和牙科因素的评估中，发现以下因素在患有TMD的青少年中起重要作用：压力、躯体主诉和情绪问题。在一项随机对照试验中比较了三种治疗方法：仅提供简短信息、提供简短信息并使用咬合器、提供简短信息并进行放松治疗。在提供简短信息并使用咬合器的组中，60%的人——明显多于其他两组——TMD疼痛至少减轻了50%。评估了躯体和情绪刺激的影响，我们发现与健康对照组相比，患有TMD疼痛的青少年不仅对厌恶的躯体刺激，而且对愉快的躯体刺激也明显更敏感。结果表明，在年轻的TMD患者中，慢性疼痛状态不仅涉及伤害性感受过程，还涉及认知过程。总之，TMD疼痛在女孩中比在男孩中更常见，并影响日常生活。青少年的TMD疼痛最好通过传统的咬合器治疗结合简短信息来改善。
