Division of Comprehensive Oral Health - Endodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
J Oral Rehabil. 2023 Jul;50(7):537-547. doi: 10.1111/joor.13457. Epub 2023 Apr 14.
Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown.
This cross-sectional study investigated the prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed.
Patients reporting tooth pain in the 30 days before attending university clinics for nonsurgical root canal treatment or retreatment were enrolled. Before endodontic treatment, they completed questionnaires and a board-certified orofacial pain specialist/endodontic resident diagnosed TMD using published Diagnostic Criteria for TMD. Log-binomial regression models estimated prevalence ratios to quantify associations with patient characteristics.
Among 100 patients enrolled, prevalence of painful TMDs was 54%. In 26% of patients, TMD pain was unrelated to endodontic pain; in 20%, TMD contributed to their chief pain complaint; and in 8%, TMD was a sole aetiology for pain. TMD prevalence was associated with greater intensity, frequency and duration of the chief pain complaint; pain in more than one tooth; tenderness to tooth percussion and palpation; a diagnosis of symptomatic apical periodontitis; pain medication use; and psychological distress.
A majority of patients with tooth pain seeking endodontic treatment had painful TMDs; one quarter had TMD as a component or sole cause of their pain. TMD prevalence was associated with more severe symptoms and signs of tooth pain and with psychological factors. The high frequency of TMD comorbidity warrants consideration in management of endodontic patients with history of toothache.
颞下颌关节紊乱（TMD）引起的疼痛可能与牙髓痛类似，但在牙髓病患者中的流行程度尚不清楚。
本横断面研究调查了因牙痛而接受牙髓治疗的患者中出现 TMD 疼痛的患病率。还评估了 TMD 疼痛对主诉的贡献以及与 TMD 患病率相关的特征。
在前往大学诊所接受非手术根管治疗或再治疗之前的 30 天内，报告有牙齿疼痛的患者被纳入研究。在牙髓治疗前，他们完成了问卷调查，由经过认证的口腔颌面疼痛专家/牙髓住院医师根据发布的 TMD 诊断标准诊断 TMD。使用对数二项式回归模型估计患病率比，以量化与患者特征的关联。
在纳入的 100 名患者中，TMD 疼痛的患病率为 54%。在 26%的患者中，TMD 疼痛与牙髓痛无关；在 20%的患者中，TMD 是其主要疼痛主诉的一部分；在 8%的患者中，TMD 是疼痛的唯一病因。TMD 患病率与主诉疼痛的强度、频率和持续时间增加、超过一颗牙齿疼痛、牙齿叩诊和触诊时压痛、诊断为症状性根尖周炎、使用止痛药物和心理困扰有关。
寻求牙髓治疗的牙痛患者中，大多数有 TMD 疼痛；四分之一的患者的 TMD 是其疼痛的组成部分或唯一病因。TMD 患病率与牙齿疼痛的症状和体征更严重以及心理因素有关。TMD 共病的高频率需要在管理有牙痛病史的牙髓病患者时加以考虑。
