Sharma S, Ohrbach R, Fillingim R B, Greenspan J D, Slade G
Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Skåne, Sweden.
Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, USA.
J Dent Res. 2020 May;99(5):530-536. doi: 10.1177/0022034520913247. Epub 2020 Mar 20.
This study evaluates contributions of jaw injury and experimental pain sensitivity to risk of developing painful temporomandibular disorder (TMD). Data were from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) nested case-control study of incident painful TMD. Injury and subsequent onset of painful TMD were monitored prospectively for ≤5 y in a community-based sample of 409 US adults who did not have TMD when enrolled. At baseline, thermal-pressure and pinprick pain sensitivity, as potential effect modifiers, were measured using quantitative sensory testing. During follow-up, jaw injury from any of 9 types of potentially traumatic events was determined using quarterly (3-monthly) health update questionnaires. Study examiners classified incident painful TMD, yielding 233 incident cases and 176 matched controls. Logistic regression models, estimated incidence odds ratios (IORs), and 95% confidence limits (CLs) were used for the association between injury and subsequent onset of painful TMD. During follow-up, 38.2% of incident cases and 13.1% of controls reported 1 or more injuries that were 4 times as likely to be intrinsic (i.e., sustained mouth opening or yawning) as extrinsic (e.g., dental visits, whiplash). Injuries due to extrinsic events (IOR = 7.6; 95% CL, 1.6-36.2), sustained opening (IOR = 5.4; 95% CL, 2.4-12.2), and yawning (IOR = 3.4; 95% CL, 1.6-7.3) were associated with increased TMD incidence. Both a single injury (IOR = 6.0; 95% CL, 2.9-12.4) and multiple injuries (IOR = 9.4; 95% CL, 3.4,25.6) predicted greater incidence of painful TMD than events perceived as noninjurious (IOR = 1.9; 95% CL, 1.1-3.4). Injury-associated risk of painful TMD was elevated in people with high sensitivity to heat pain (IOR = 7.4; 95% CL, 3.1-18.0) compared to people with low sensitivity to heat pain (IOR = 3.9; 95% CL, 1.7-8.4). Jaw injury was strongly associated with elevated painful TMD risk, and the risk was amplified in subjects who had enhanced sensitivity to heat pain at enrollment. Commonly occurring but seemingly innocuous events, such as yawning injury, should not be overlooked when judging prognostic importance of jaw injury.
本研究评估颌部损伤及实验性疼痛敏感性对发生疼痛性颞下颌关节紊乱病（TMD）风险的影响。数据来自口面部疼痛：前瞻性评估与风险评估（OPPERA）这一关于新发疼痛性TMD的巢式病例对照研究。在一个基于社区的409名美国成年人样本中，对损伤及随后疼痛性TMD的发病情况进行了为期≤5年的前瞻性监测，这些成年人在入组时没有TMD。在基线时，使用定量感觉测试测量热压和针刺疼痛敏感性，作为潜在的效应修饰因素。在随访期间，通过每季度（每3个月）的健康更新问卷确定9种潜在创伤性事件中任何一种导致的颌部损伤。研究检查人员对新发疼痛性TMD进行分类，产生了233例新发病例和176例匹配对照。使用逻辑回归模型、估计发病率比值比（IOR）和95%置信区间（CL）来分析损伤与随后疼痛性TMD发病之间的关联。在随访期间，38.2%的新发病例和13.1%的对照报告有1次或更多次损伤，其中内在损伤（即持续张口或打哈欠）发生的可能性是外在损伤（如看牙医、挥鞭样损伤）的4倍。由外在事件导致的损伤（IOR = 7.6；95% CL，1.6 - 36.2）、持续张口（IOR = 5.4；95% CL，2.4 - 12.2）和打哈欠（IOR = 3.4；95% CL，1.6 - 7.3）与TMD发病率增加相关。单次损伤（IOR = 6.0；95% CL，2.9 - 12.4）和多次损伤（IOR = 9.4；95% CL，3.4 - 25.6）均比被视为无损伤的事件（IOR = 1.9；95% CL，1.1 - 3.4）更能预测疼痛性TMD的更高发病率。与热痛敏感性低的人相比（IOR = 3.9；95% CL，1.7 - 8.4），热痛敏感性高的人因损伤导致疼痛性TMD的风险升高（IOR = 7.4；95% CL，3.1 - 18.0）。颌部损伤与疼痛性TMD风险升高密切相关，并且在入组时对热痛敏感性增强的受试者中风险会放大。在判断颌部损伤的预后重要性时，诸如打哈欠损伤等常见但看似无害的事件不应被忽视。
