Department of Stomatognathic Physiology, Kalmar County Hospital, Kalmar, Sweden.
Regional Center for Child and Youth Mental Health and Child Welfare - Central Norway, Norwegian University of Science and Technology, Trondheim, Norway.
Clin Exp Dent Res. 2020 Aug;6(4):407-414. doi: 10.1002/cre2.289. Epub 2020 Apr 18.
To evaluate the course of pain intensity and frequency related to temporomandibular disorders (TMDs) 15 years (range 5-21 years) after having received TMD treatment as adolescents due to frequent (at least once a week) TMD pain in two controlled trials.
In the first trial, subjects (n = 122) were randomly allocated to either information only, received in a control condition (Co), or information and an occlusal appliance (OA) versus relaxation therapy (RT). In the second trial, including 64 subjects, nonresponders to OA or RT were subsequently allocated to the alternate treatment (ST). All study participants having completed the trials (n = 167) were invited to a long-term follow-up evaluations, with a response rate of 69.5% (n = 116). Patient-reported outcomes of TMD-related frequency and intensity were appraised relative to baseline data and short-term outcomes as observed in the two trials by use of general linear mixed model and generalized estimation equation statistics.
A significantly higher proportion of participants treated with OA and in the combined RT/Co condition than those in the ST group, reported a frequency level of TMD pain less than once week at post-treatment and the long-term follow-up. Adolescents treated with OA showed significantly lower TMD pain intensity levels post-treatment than those in the other two treatment conditions. While no difference between the OA and the RT/Co conditions was found in the long-term follow-up, participants in these two conditions were significantly more improved than those in the ST group.
Adolescents treated with an OA clearly showed better outcome with regard to intensity and frequency in a long-term follow-up of TMD pain than those treated with RT and ST for nonresponders. These latter individuals need special clinical attention and more effective supplementary treatment methods to be developed.
评估青少年因频发颞下颌关节紊乱（TMD）疼痛（每周至少一次）接受 TMD 治疗 15 年后（范围 5-21 年）疼痛强度和频率的变化过程。该研究共纳入两项对照试验。
在第一项试验中，122 名受试者被随机分配至仅接受信息（对照组 Co）、接受信息联合咬合垫（OA）或松弛疗法（RT）治疗组。在第二项试验中，包括 64 名未对 OA 或 RT 产生应答的受试者，他们随后被分配至交替治疗（ST）组。所有完成两项试验的研究参与者（n = 167）均被邀请参加长期随访评估，应答率为 69.5%（n = 116）。使用一般线性混合模型和广义估计方程统计，对 TMD 相关频率和强度的患者报告结局进行评估，比较基线数据和两项试验中的短期结局。
与 ST 组相比，接受 OA 治疗和联合 RT/Co 治疗的参与者中，报告 TMD 疼痛频率每周少于一次的比例明显更高，在治疗后和长期随访时均如此。接受 OA 治疗的青少年治疗后 TMD 疼痛强度显著低于其他两种治疗条件。虽然在长期随访中未发现 OA 与 RT/Co 之间的差异，但这两种条件的参与者明显比 ST 组改善更多。
与 RT 和 ST 治疗非应答者相比，接受 OA 治疗的青少年在 TMD 疼痛的长期随访中，其疼痛强度和频率的改善更为显著。这些后者需要特殊的临床关注，并需要开发更有效的补充治疗方法。
