Kobayashi Fernanda Yukie, Gavião Maria Beatriz Duarte, Marquezin Maria Carolina Salomé, Fonseca Fernando Luiz Affonso, Montes Ana Bheatriz Marangoni, Barbosa Taís de Souza, Castelo Paula Midori
Universidade de Campinas - Unicamp, Piracicaba Dental School, , Department of Pediatric Dentistry University of Campinas, Piracicaba, SP, Brazil.
Universidade Federal de São Paulo - Unifesp, Department of Pharmaceutical Sciences, Diadema, SP, Brazil.
Braz Oral Res. 2017 Sep 28;31:e78. doi: 10.1590/1807-3107BOR-2017.vol31.0078.
The etiology of temporomandibular disorders (TMD), which are considered as a heterogeneous group of psychophysiological disturbances, remains a controversial issue in clinical dentistry. This study aimed to evaluate whether the salivary alpha-amylase (sAA), cortisol levels, and anxiety symptoms differ between children with and without TMD. Initially, 316 young subjects were screened in public schools (nonreferred sample); 76 subjects aged 7-14 years were selected and comprised the TMD and control groups with 38 subjects each matched by sex, age, and the presence/absence of sleep bruxism. Four saliva samples were collected: upon waking, 30 min and 1 h after awakening (fasting), and at night (at 8 PM) on 2 alternate days to examine the diurnal profiles of cortisol and sAA. Anxiety symptoms were screened using the Multidimensional Anxiety Scale for Children (MASC-Brazilian version). Shapiro-Wilk test, Student's t-test/Mann-Whitney U test, and correlation tests were used for data analysis. No significant differences were observed in the salivary cortisol area under the curve (AUCG mean ± SD = 90.22 ± 63.36 × 94.21 ± 63.13 µg/dL/min) and sAA AUCG (mean ± SD = 2544.52 ± 2142.00 × 2054.03 ± 1046.89 U/mL/min) between the TMD and control groups, respectively (p > 0.05); however, the clinical groups differed in social anxiety domain (t = 3.759; CI = 2.609, 8.496), separation/panic (t = 2.243; CI = 0.309, 5.217), physical symptoms (U = 433.500), and MASC total score (t = -3.527; CI = -23.062, -6.412), with a power of the test >80% and large effect size (d = 0.80), with no significant correlation between the MASC total score, cortisol, and sAA levels. Although children with TMD scored higher in anxiety symptoms, no difference was observed in the salivary stress biomarkers between children with and without TMD.
颞下颌关节紊乱病（TMD）被认为是一组异质性的心理生理障碍，其病因在临床牙科中仍然是一个有争议的问题。本研究旨在评估患TMD和未患TMD的儿童之间唾液α淀粉酶（sAA）、皮质醇水平和焦虑症状是否存在差异。最初，在公立学校对316名年轻受试者进行了筛查（非转诊样本）；选择了76名7至14岁的受试者，组成TMD组和对照组，每组38名，根据性别、年龄和是否存在睡眠磨牙症进行匹配。收集了四份唾液样本：醒来时、醒来后30分钟和1小时（空腹）以及在两个交替日的晚上（晚上8点），以检查皮质醇和sAA的昼夜变化情况。使用儿童多维焦虑量表（巴西版）筛查焦虑症状。采用夏皮罗-威尔克检验、学生t检验/曼-惠特尼U检验和相关性检验进行数据分析。TMD组和对照组之间唾液皮质醇曲线下面积（AUCG均值±标准差=90.22±63.36×94.21±63.13µg/dL/min）和sAA AUCG（均值±标准差=2544.52±2142.00×2054.03±1046.89 U/mL/min）均未观察到显著差异（p>0.05）；然而，临床组在社交焦虑领域（t=3.759；CI=2.609，8.496）、分离/惊恐（t=2.243；CI=0.309，5.217）、躯体症状（U=433.500）和MASC总分（t=-3.527；CI=-23.062，-6.412）方面存在差异，检验效能>80%，效应量较大（d=0.80），MASC总分、皮质醇和sAA水平之间无显著相关性。虽然患TMD的儿童在焦虑症状方面得分较高，但患TMD和未患TMD的儿童之间唾液应激生物标志物未观察到差异。
