Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
Psychology, Potsdam, Germany.
J Oral Rehabil. 2024 Jun;51(6):1025-1033. doi: 10.1111/joor.13678. Epub 2024 Mar 12.
Longitudinal intervention studies on treatment options in temporomandibular dysfunction (TMD) including self reports and salivary biomarkers of stress are rare and the exact therapeutic function of occlusal splints widely unknown.
We examined the therapeutic effects of a Michigan splint with occlusal relevance in patients with TMD using a placebo-controlled, delayed-start design. Two intervention groups received a Michigan splint, while one of them had a placebo palatine splint for the first 3 weeks. We collected pain intensities (at rest and after five occlusal movements), salivary measures associated with stress (cortisol and alpha-amylase) and self-reported psychological distress (stress, anxiety, catastrophizing) at baseline and 3 and 7 weeks after onset of intervention.
At baseline, we observed increased pain intensity and psychological distress in TMD patients compared to 11 matched healthy controls. Baseline anxiety was linked to movement pain intensity through stress. Over therapy reductions in pain intensity and morning cortisol were more pronounced in those patients starting immediately with the Michigan splint, while psychological distress decreased similarly in both groups.
Our results suggest that perceived stress plays a role for the association between anxiety and TMD pain and underlines the need for an interdisciplinary perspective on the pathogenesis and therapy of TMD in a setting where psychotherapeutic knowledge is still scarce or rarely applied.
关于颞下颌功能紊乱（TMD）治疗选择的纵向干预研究，包括自我报告和压力的唾液生物标志物，很少见，咬合夹板的确切治疗作用也知之甚少。
我们采用安慰剂对照、延迟启动设计，检查了具有咬合相关性的密歇根夹板对 TMD 患者的治疗效果。两组干预组均接受密歇根夹板治疗，其中一组在前 3 周使用安慰剂腭夹板。我们在基线时以及干预开始后 3 周和 7 周时收集疼痛强度（休息时和进行 5 次咬合运动后）、与压力相关的唾液测量值（皮质醇和α-淀粉酶）以及自我报告的心理困扰（压力、焦虑、灾难化）。
在基线时，与 11 名匹配的健康对照组相比，TMD 患者的疼痛强度和心理困扰增加。基线焦虑通过压力与运动疼痛强度相关。在那些立即开始使用密歇根夹板的患者中，治疗过程中疼痛强度和早晨皮质醇的减少更为明显，而两组的心理困扰则相似下降。
我们的研究结果表明，感知到的压力在焦虑与 TMD 疼痛之间的关系中起作用，并强调在心理治疗知识仍然匮乏或很少应用的情况下，需要从跨学科的角度来研究 TMD 的发病机制和治疗。
