Clark G T
University of California-Los Angeles, School of Dentistry.
Adv Dent Res. 1991 Dec;5:60-6. doi: 10.1177/08959374910050010901.
Over the last 75 years, a variety of etiologic factors has been suggested as the cause of pain and dysfunction in the temporomandibular system. The earliest and still-popular etiologic theory proposed that temporomandibular disorders are induced by abnormal structure, usually described as a malocclusion of the teeth or jaws. The fact that this theory was based on mechanical concepts, ignored biologic diversity, and had limited factual experimental evidence to support it as well as extensive evidence in opposition did not seem to matter to its proponents. In the late 1960's and early 1970's, the structural occlusal model for TM Disorders was challenged and has yielded ground to a more multifactorial model of TMD causation. Other etiologic factors for TM disorders--such as anatomical susceptibility of TM tissues to trauma, polyarthritic diseases, joint laxity, repetitive parafunctional behaviors, and stress-related muscle dysfunction--need to be recognized and quantified. Unfortunately, many practicing dentists demonstrate a very poor understanding of and often fail to recognize these etiologic factors as agents that produce TM disorders. This failure is largely due to the fact that the dental profession has spent the last 90 years dealing with a variety of misconceptions about the etiology of temporomandibular disorders. In the 1990's, one of the more formidable challenges we face is acquiring the ability to segregate and define validly the specific TM Disorder of concern and then correctly identify and measure the specific etiologic factors that produce it. Until these problems are solved, it is unlikely that we will be able to prevent disease of the TM apparatus.
在过去75年里，人们提出了多种病因因素，认为它们是颞下颌系统疼痛和功能障碍的成因。最早且至今仍流行的病因理论认为，颞下颌紊乱症是由异常结构诱发的，通常指牙齿或颌骨的咬合不正。该理论基于机械概念，忽视了生物多样性，支持它的事实性实验证据有限，且有大量相反证据，但这对其支持者来说似乎无关紧要。在20世纪60年代末和70年代初，颞下颌紊乱症的结构咬合模型受到挑战，并逐渐被更具多因素的颞下颌紊乱症病因模型所取代。颞下颌紊乱症的其他病因因素——如颞下颌组织对创伤的解剖易感性、多关节炎疾病、关节松弛、重复性副功能行为以及与压力相关的肌肉功能障碍——需要得到认识和量化。不幸的是，许多执业牙医对这些病因因素的理解非常欠缺，常常未能将它们视为导致颞下颌紊乱症的因素。这种失误很大程度上是因为在过去90年里，牙科行业一直受关于颞下颌紊乱症病因的各种误解所困扰。在20世纪90年代，我们面临的一个更严峻的挑战是有能力区分并有效界定所关注的特定颞下颌紊乱症，然后正确识别和测量导致该病症的特定病因因素。在这些问题得到解决之前，我们不太可能预防颞下颌关节装置的疾病。
