Cooper Barry C, Kleinberg Israel
Cranio. 2007 Apr;25(2):114-26. doi: 10.1179/crn.2007.018.
Temporomandibular Disorder (TMD) is a term generally applied to a condition or conditions characterized by pain and/or dysfunction of the masticatory apparatus. Its characterization has been difficult because of the large number of symptoms and signs attributed to this disorder and to variation in the number and types manifested in any particular patient. For this study, data on 4,528 patients, presenting over a period of 25 years to a single examiner for TMD treatment, was made available for retrospective analysis and determination of whether the TMD care-seeking patient can be profiled, particularly pain difficulties. All patients in this database filled out a questionnaire and were examined for the prevalence of a range of symptoms and clinical examination findings (signs) commonly attributed to TMD. There was no attempt in this study to assign patients to TMD diagnostic subcategories. The data collected were analyzed to determine which of these symptoms and signs were sufficiently "characteristic of the TMD condition" that they might be used in diagnosis, research and treatment, especially in patients needing relief from pain and discomfort. All 4,528 patients reported symptoms and all but 190 of them also showed signs upon examination. Symptoms most commonly reported on the questionnaire included (i) pain (96.1%), (ii) headache (79.3%), (iii) temporomandibular joint discomfort or dysfunction (75.0%) and (iv) ear discomfort or dysfunction (82.4%). In the 4,338 patients who showed signs, the most prevalent was tenderness to palpation of the pterygoid muscles (85.1%), followed by tenderness to palpation of the temporomandibular joints (62.4%). Pain symptoms and signs were often accompanied by compromised mandibular movements, TMJ sounds and dental changes, such as incisal edge wear and excessive overbite. Clearly prevalence of pain disclosed by the symptoms and signs examinations was high. Patients showed variable prevalence and nonprevalence of eight categories of painful symptoms and seven categories of painful signs. Despite the variability, these might be developed in the future into TMD scores or indices for studying and unraveling the TMD conundrum.
颞下颌关节紊乱病(TMD)是一个通常用于描述咀嚼器官出现疼痛和/或功能障碍的一种或多种病症的术语。由于该病症存在大量症状和体征,且不同患者表现出的症状数量和类型各不相同,因此对其进行特征描述颇具难度。在本研究中,收集了25年间由同一位检查者诊治的4528例TMD患者的数据,用于回顾性分析,并确定是否可以对寻求TMD治疗的患者进行特征分析,尤其是疼痛问题。该数据库中的所有患者均填写了问卷,并接受了一系列通常归因于TMD的症状和临床检查结果(体征)的患病率检查。本研究未尝试将患者分配到TMD诊断亚类中。对收集到的数据进行分析,以确定哪些症状和体征具有足够的“TMD病症特征”,可用于诊断、研究和治疗,尤其是对需要缓解疼痛和不适的患者。4528例患者均报告了症状,除190例患者外,其余患者检查时也均表现出体征。问卷中最常报告的症状包括:(i)疼痛(96.1%),(ii)头痛(79.3%),(iii)颞下颌关节不适或功能障碍(75.0%),以及(iv)耳部不适或功能障碍(82.4%)。在4338例有体征的患者中,最常见的是翼状肌触压痛(85.1%),其次是颞下颌关节触压痛(62.4%)。疼痛症状和体征常伴有下颌运动受限、颞下颌关节弹响和牙齿变化,如切缘磨损和深覆合。显然,症状和体征检查所揭示的疼痛患病率很高。患者在八类疼痛症状和七类疼痛体征中的患病率和无患病率各不相同。尽管存在变异性,但这些症状和体征未来可能会发展为TMD评分或指数,用于研究和解决TMD难题。
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