Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Clin Oral Investig. 2012 Jun;16(3):689-97. doi: 10.1007/s00784-011-0555-6. Epub 2011 May 3.
The objective of this study was to assess variations in the occurrence of temporomandibular disorders (TMDs) and the risk of developing pain and function impairment of the temporomandibular complex in obstructive sleep apnea syndrome (OSAS) patients treated with either an oral appliance (mandibular advancement device) or continuous positive airway pressure (CPAP) in a 2-year follow-up study. In addition, we assessed the relationship between the mean mandibular protrusion and the frequency of wearing the appliance during follow-up with the occurrence of pain and function impairment of the temporomandibular complex. Fifty-one patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. TMDs (diagnosed according to the Axis I Research Diagnostic Criteria for TMD), pain intensity and disability and mandibular function impairment were recorded at baseline, after 2 months, 1 year and 2 years of therapy. Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher (24%) in the oral appliance group compared to CPAP (6%). Oral appliance therapy furthermore resulted in more temporomandibular pain compared to CPAP (odds ratio 2.33, 95% confidence interval (1.22-4.43)). However, there were no limitations in mandibular function in both groups during the (entire) follow-up period. Although generally not serious and of transient nature, oral appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy. Oral appliance therapy is associated with increased pain in the temporomandibular complex in the initial period of use. Because of the transient nature, this pain is not a reason to contra-indicate an oral appliance in OSAS patients. Moreover, TMDs and the risk of developing pain and function impairment of the temporomandibular complex appear limited with long-term oral appliance use.
本研究旨在评估在为期 2 年的随访中，使用口腔矫治器（下颌前伸装置）或持续气道正压通气（CPAP）治疗的阻塞性睡眠呼吸暂停综合征（OSAS）患者中，颞下颌关节紊乱（TMD）的发生情况和颞下颌复合体疼痛及功能障碍的风险变化，以及平均下颌前伸量与随访期间佩戴矫治器的频率与颞下颌复合体疼痛及功能障碍发生的关系。51 例患者随机分为口腔矫治器治疗组，52 例患者分为 CPAP 治疗组。在基线、治疗 2 个月、1 年和 2 年后，记录 TMD（根据 TMD 轴 I 研究诊断标准诊断）、疼痛强度和残疾以及下颌功能障碍。仅在治疗的初始阶段，口腔矫治器组发生与疼痛相关的 TMD 的几率（24%）明显高于 CPAP 组（6%）。与 CPAP 相比，口腔矫治器治疗还会导致更多的颞下颌疼痛（优势比 2.33，95%置信区间 1.22-4.43）。然而，在整个随访期间，两组的下颌功能均无受限。虽然一般不严重且为一过性，但是与 CPAP 治疗相比，口腔矫治器治疗在使用的初始阶段会导致更多与疼痛相关的 TMD。口腔矫治器治疗在使用的初始阶段会导致颞下颌复合体疼痛增加。由于这种疼痛是一过性的，因此不应将其作为 OSAS 患者使用口腔矫治器的禁忌症。此外，TMD 和发生颞下颌复合体疼痛及功能障碍的风险在长期使用口腔矫治器后似乎受到限制。
