Kolbinson D A, Epstein J B, Senthilselvan A, Burgess J A
Department of Diagnostic and Surgical Sciences, University of Saskatchewan, College of Dentistry, Saskatoon, Canada.
J Orofac Pain. 1997 Fall;11(4):337-45.
The influence of previous trauma in the management of patients with temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare treatment regimens and outcomes in motor vehicle accident trauma-related versus nontrauma-related TMD patients. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed. Information concerning treatment received, progress of symptoms with treatment, and findings from the final examination were recorded. As a whole group, posttraumatic TMD patients tended to receive more types of treatment (P < .0001), have more medications prescribed (including analgesics, P < .001; nonsteroidal anti-inflammatory drugs, P = .001; muscle relaxants, P = .001; and tricyclic antidepressants, P < .001), have more oral medicine clinic visits (P = .07) over a longer period of time (P = .06), and have a poorer treatment outcome (P < .001) as compared to the nontrauma group. When the patients were separated into TMD diagnostic classification subsets, only some of these differences between trauma and nontrauma patients were seen, but the subset group sizes were small and only a few of the groups could be compared. There did not seem to be a significant effect from settling insurance claims prior to the last clinic visit. Trauma may be an important prognostic factor in the management of some TMD patients.
既往创伤对颞下颌关节紊乱病（TMD）患者治疗的影响存在争议。本研究的目的是比较机动车事故创伤相关与非创伤相关TMD患者的治疗方案和治疗结果。回顾了50例创伤性TMD患者和50例匹配的非创伤性TMD患者的病历。记录了所接受治疗的相关信息、治疗过程中症状的进展以及最终检查的结果。作为一个整体组，创伤后TMD患者倾向于接受更多类型的治疗（P <.0001），开具更多种类的药物（包括镇痛药，P <.001；非甾体抗炎药，P =.001；肌肉松弛剂，P =.001；三环类抗抑郁药，P <.001），在更长的时间内有更多的口腔门诊就诊次数（P =.07）（P =.06），并且与非创伤组相比治疗效果更差（P <.001）。当将患者分为TMD诊断分类亚组时，创伤患者与非创伤患者之间仅出现了部分上述差异，但亚组样本量较小，且仅有少数几组可以进行比较。在上次门诊就诊前解决保险理赔似乎没有显著影响。创伤可能是某些TMD患者治疗中的一个重要预后因素。
