Melchior Melissa de Oliveira, Mazzetto Marcelo Oliveira, Magri Laís Valencise
Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto (SP), Brasil.
Codas. 2019 Apr 1;31(2):e20180161. doi: 10.1590/2317-1782/20182018161.
To analyze the mandibular movements of patients with painful TMD during the speech function in order to understand possible alterations and which subgroups of patients may present them. In addition to identifying which signs and symptoms related to painful TMD are perceived in the performance of this function.
Thirty-two subjects aged between 18-60 years old (35.1 ± 8.9), 23 with TMD ( DC/TMD; eight men and 15 women) and nine controls were evaluated regarding: self-perception of TMD signs and symptoms during speech (ProTMDMulti); range of mandibular movements during the reading of a word list (electrognatography, Jaw Motion Analyzes). The percentage of movement usage during the speech performance as a function of maximum individual amplitude was calculated, and groups of patients with painful TMD (TMD-D) and painful/joint (TMD-D/A) were subdivided.
The TMD-D/A group presented a higher percentage of use of lateral movement during speech than the other groups. Pain, joint noise, and difficulty in speaking were the most commonly reported signs/symptoms of speech performance. The perception of joint noises and the presence of lateral deviations were significantly higher in the TMD-D/A group (p<0.05).
The lateral deviations are the main alteration of the mandibular movement during the speech performance in painful TMD. Such deviations are more expected in joint TMD (disc displacement and degenerative diseases). The perception of pain and joint noise are the main complaints related to the orofacial speech function in individuals with painful TMD.
分析颞下颌关节紊乱病（TMD）疼痛患者在言语功能过程中的下颌运动，以了解可能存在的改变以及哪些患者亚组可能出现这些改变。此外，还要确定在该功能执行过程中哪些与疼痛性TMD相关的体征和症状会被感知到。
对32名年龄在18至60岁之间（35.1±8.9）的受试者进行评估，其中23名患有TMD（DC/TMD；8名男性和15名女性），9名作为对照，评估内容包括：言语过程中TMD体征和症状的自我感知（ProTMDMulti）；阅读单词列表时的下颌运动范围（电子下颌运动描记法，下颌运动分析）。计算言语表现过程中运动使用百分比与个体最大幅度的函数关系，并对疼痛性TMD患者组（TMD-D）和疼痛/关节型患者组（TMD-D/A）进行细分。
TMD-D/A组在言语过程中侧向运动的使用百分比高于其他组。疼痛、关节弹响和说话困难是言语表现中最常报告的体征/症状。TMD-D/A组中关节弹响的感知和侧向偏斜的存在显著更高（p<0.05）。
侧向偏斜是疼痛性TMD患者言语表现过程中下颌运动的主要改变。这种偏斜在关节型TMD（盘移位和退行性疾病）中更常见。疼痛和关节弹响的感知是疼痛性TMD患者与口面部言语功能相关的主要主诉。
