Greene C S
Department of Orthodontics, Northwestern University Dental School, Chicago, IL, USA.
Semin Orthod. 1995 Dec;1(4):222-8. doi: 10.1016/s1073-8746(95)80053-0.
This article discusses the subject of causation (etiology) as it has been applied to the field of temporomandibular disorders (TMD). These disorders have been the focus of considerable disagreement about what constitutes proper diagnosis and treatment, and it is clear that the main basis for these controversies has been conflicting views about the etiology of the various disorders. Many earlier theories emphasized dental morphological factors of malocclusion, occlusal dysharmony, and bad mandibular alignment as being primarily responsible for the development of TMD symptoms. Certain versions of these dental/skeletal concepts have long been a part of the belief system of the orthodontic specialty, leading to some special orthodontic protocols for managing TM disorders. Today, it is generally agreed that the etiology of TM disorders includes a multifactorial combination of physical and psychosocial factors, with some of them being either poorly understood or difficult to assess. In most cases, there are no special occlusal or orthodontic factors to be considered, and therefore occlusion-changing procedures are not generally required for successful treatment. This means that contemporary orthodontists must face the same challenge as all their other dental colleagues: to learn about modern concepts of diagnosis and treatment for all types of orofacial pain patients, and then to use currently recommended protocols for pain management and musculoskeletal therapy for those patients who have temporomandibular disorders.
本文讨论了因果关系（病因学）这一主题在颞下颌关节紊乱病（TMD）领域的应用。这些疾病在什么构成正确诊断和治疗方面一直存在很大分歧，很明显，这些争议的主要根源在于对各种疾病病因的相互冲突的观点。许多早期理论强调错牙合、咬合不协调和下颌排列不良等牙齿形态学因素是TMD症状发展的主要原因。这些牙齿/骨骼概念的某些版本长期以来一直是正畸专业信念体系的一部分，导致了一些治疗颞下颌关节紊乱的特殊正畸方案。如今，人们普遍认为颞下颌关节紊乱病的病因包括身体和心理社会因素的多因素组合，其中一些因素要么理解不足，要么难以评估。在大多数情况下，不存在需要考虑的特殊咬合或正畸因素，因此成功治疗通常不需要改变咬合的程序。这意味着当代正畸医生必须面对与所有其他牙科同事相同的挑战：了解所有类型口面部疼痛患者的现代诊断和治疗概念，然后为患有颞下颌关节紊乱病的患者使用当前推荐的疼痛管理和肌肉骨骼治疗方案。
