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颌部疾病:识别、起源、治疗与预防

The Jaw Epidemic: Recognition, Origins, Cures, and Prevention.

作者信息

Kahn Sandra, Ehrlich Paul, Feldman Marcus, Sapolsky Robert, Wong Simon

出版信息

Bioscience. 2020 Jul 22;70(9):759-771. doi: 10.1093/biosci/biaa073. eCollection 2020 Sep.

Abstract

Contemporary humans are living very different lives from those of their ancestors, and some of the changes have had serious consequences for health. Multiple chronic "diseases of civilization," such as cardiovascular problems, cancers, ADHD, and dementias are prevalent, increasing morbidity rates. Stress, including the disruption of traditional sleep patterns by modern lifestyles, plays a prominent role in the etiology of these diseases, including obstructive sleep apnea. Surprisingly, jaw shrinkage since the agricultural revolution, leading to an epidemic of crooked teeth, a lack of adequate space for the last molars (wisdom teeth), and constricted airways, is a major cause of sleep-related stress. Despite claims that the cause of this jaw epidemic is somehow genetic, the speed with which human jaws have changed, especially in the last few centuries, is much too fast to be evolutionary. Correlation in time and space strongly suggests the symptoms are phenotypic responses to a vast natural experiment-rapid and dramatic modifications of human physical and cultural environments. The agricultural and industrial revolutions have produced smaller jaws and less-toned muscles of the face and oropharynx, which contribute to the serious health problems mentioned above. The mechanism of change, research and clinical trials suggest, lies in orofacial posture, the way people now hold their jaws when not voluntarily moving them in speaking or eating and especially when sleeping. The critical resting oral posture has been disrupted in societies no longer hunting and gathering. Virtually all aspects of how modern people function and rest are radically different from those of our ancestors. We also briefly discuss treatment of jaw symptoms and possible clinical cures for individuals, as well as changes in society that might lead to better care and, ultimately, prevention.

摘要

当代人类的生活与他们的祖先截然不同,其中一些变化对健康产生了严重影响。多种慢性“文明病”,如心血管问题、癌症、注意力缺陷多动障碍和痴呆症普遍存在,发病率不断上升。压力,包括现代生活方式对传统睡眠模式的干扰,在这些疾病的病因中起着重要作用,包括阻塞性睡眠呼吸暂停。令人惊讶的是,自农业革命以来颌骨缩小,导致牙齿不齐、最后一颗磨牙(智齿)缺乏足够空间以及气道变窄的流行,是与睡眠相关压力的主要原因。尽管有人声称这种颌骨问题的原因在某种程度上是遗传的,但人类颌骨变化的速度,尤其是在过去几个世纪,太快了,不可能是进化的结果。时间和空间上的相关性强烈表明,这些症状是对一项大规模自然实验——人类自然和文化环境的快速而显著改变——的表型反应。农业和工业革命导致了颌骨变小以及面部和口咽肌肉张力降低,这促成了上述严重的健康问题。研究和临床试验表明,变化的机制在于口面部姿势,即人们在说话或进食时不自主移动颌骨,尤其是在睡觉时保持颌骨的方式。在不再以狩猎和采集为生的社会中,关键的静息口腔姿势已经被打乱。现代人的功能和休息方式几乎在所有方面都与我们的祖先截然不同。我们还简要讨论了颌骨症状的治疗方法以及可能的个体临床治疗方法,以及社会变革,这些变革可能带来更好的护理,最终实现预防。

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