Wahlund Kerstin, Larsson Bo
a Department of Stomatognathic Physiology , Kalmar County Hospital , Kalmar , Sweden.
b Regional Center for Child and Youth Mental Health and Child Welfare - Central Norway , Norwegian University of Science and Technology , Trondheim , Norway.
Acta Odontol Scand. 2018 Apr;76(3):153-160. doi: 10.1080/00016357.2017.1394490. Epub 2017 Oct 26.
This study aims to evaluate long-term, self-perceived outcome in adulthood for individuals treated as adolescents for temporomandibular disorder (TMD) pain in two previous randomized controlled trials (RCTs).
The study included 116 subjects (81% females) treated for frequent TMD pain in two separate RCTs 5-21 (M = 14.8, SD =4.9) years previously. Treatment consisted of occlusal appliance (OA) (n = 41, 35.3%) or relaxation training (RT) combined with information for the control (Co) group (n = 50, 43.1%), both compared to non-responders receiving additional, sequential treatment (ST) in a crossover study (n = 25, 21.6%). Participants answered a questionnaire on their experience of frequency and intensity of TMD pain impaired chewing capacity and daily social activities, help-seeking behaviour and treatment, general health, other pain, and depressive symptoms.
Older participants reported lower levels of frequency and intensity of TMD pain, impairment, and depressive symptoms, as well as better general health. Females reported more frequent and more intense TMD pain, greater impairment and more often reported 'other pain' compared to males. Non-responders receiving ST experienced significantly more TMD, and other pain and higher impairment levels compared to other groups. Those treated with an OA had sought additional treatment significantly less often since the RCTs than ST and RT/Co-treated individuals.
Adolescents treated with OA showed somewhat better sustained improvement over the extended follow-up period than those treated with RT/Co. Non-responders to treatment and females exhibited a poorer outcome. These groups need particular attention and extended or different treatments to achieve a better long-term outcome.
本研究旨在评估在之前两项随机对照试验（RCT）中作为青少年接受颞下颌关节紊乱病（TMD）疼痛治疗的个体在成年期的长期自我感知结果。
该研究纳入了116名受试者（81%为女性），他们在5 - 21（平均 = 14.8，标准差 = 4.9）年前的两项独立RCT中接受了频繁TMD疼痛的治疗。治疗包括咬合矫治器（OA）（n = 41，35.3%）或放松训练（RT）并向对照组（Co）提供信息（n = 50，43.1%），在一项交叉研究中，这两组均与接受额外序贯治疗（ST）的无反应者进行比较（n = 25，21.6%）。参与者回答了一份关于他们TMD疼痛的频率和强度、咀嚼能力受损、日常社交活动、寻求帮助行为和治疗、总体健康、其他疼痛以及抑郁症状的问卷。
年龄较大的参与者报告TMD疼痛的频率和强度、功能损害以及抑郁症状水平较低，总体健康状况较好。与男性相比，女性报告的TMD疼痛更频繁、更强烈，功能损害更大，且更常报告“其他疼痛”。与其他组相比，接受ST的无反应者经历的TMD、其他疼痛和功能损害水平明显更高。自RCT以来，接受OA治疗的人寻求额外治疗的频率明显低于接受ST和RT/Co治疗的个体。
在延长的随访期内，接受OA治疗的青少年比接受RT/Co治疗的青少年表现出稍好的持续改善。治疗无反应者和女性的结果较差。这些群体需要特别关注，并需要延长治疗时间或采用不同的治疗方法以获得更好的长期结果。
