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1.
    
The aim of this study was to assess the electromyographic characteristics of the masticatory muscles (masseter and temporalis) of patients with either “temporomandibular joint disorder” or “neck pain”. Surface electromyography of the right and left masseter and temporalis muscles was performed during maximum teeth clenching in 38 patients aged 21–67 years who had either (a) temporomandibular joint disorder (24 patients); (b) “neck pain” (13 patients). Ninety-five control, healthy subjects were also examined. During clenching, standardized total muscle activities (electromyographic potentials over time) were significantly different in the three groups: 75 μV/μV s % in the temporomandibular joint disorder patients, 124 μV/μV s % in the neck pain patients, and 95 μV/μV s % in the control subjects (analysis of variance, P<0.001). The temporomandibular joint disorder patients also had significantly (P<0.001) more asymmetric muscle potentials (78%) than either neck pain patients (87%) or control subjects (92%). A linear discriminant function analysis allowed a significant separation between the two patient groups, with a single patient error of 18.2%. Surface electromyographic analysis during clenching allowed to differentiate between patients with a temporomandibular joint disorder and patients with a neck pain problem.  相似文献   

2.
Velly AM  Look JO  Carlson C  Lenton PA  Kang W  Holcroft CA  Fricton JR 《Pain》2011,152(10):2377-2383
Although most cases of temporomandibular muscle and joint disorders (TMJD) are mild and self-limiting, about 10% of TMJD patients develop severe disorders associated with chronic pain and disability. It has been suggested that depression and catastrophizing contributes to TMJD chronicity. This article assesses the effects of catastrophizing and depression on clinically significant TMJD pain (Graded Chronic Pain Scale [GCPS] II-IV). Four hundred eighty participants, recruited from the Minneapolis/St. Paul area through media advertisements and local dentists, received examinations and completed the GCPS at baseline and at 18-month follow-up. In a multivariable analysis including gender, age, and worst pain intensity, baseline catastrophizing (β 3.79, P < 0.0001) and pain intensity at baseline (β 0.39, P < 0.0001) were positively associated with characteristic of pain intensity at the 18th month. Disability at the 18-month follow-up was positively related to catastrophizing (β 0.38, P < 0.0001) and depression (β 0.17, P = 0.02). In addition, in the multivariable analysis adjusted by the same covariates previously described, the onset of clinically significant pain (GCPS II-IV) at the 18-month follow-up was associated with catastrophizing (odds ratio [OR] 1.72, P = 0.02). Progression of clinically significant pain was related to catastrophizing (OR 2.16, P < 0.0001) and widespread pain at baseline (OR 1.78, P = 0.048). Results indicate that catastrophizing and depression contribute to the progression of chronic TMJD pain and disability, and therefore should be considered as important factors when evaluating and developing treatment plans for patients with TMJD.  相似文献   

3.
Appropriate management of temporomandibular disorders (TMD) requires an understanding of the underlying dysfunction associated with the temporomandibular joint (TMJ) and surrounding structures. A comprehensive examination process, as described in part 1 of this series, can reveal underlying clinical findings that assist in the delivery of comprehensive physical therapy services for patients with TMD. Part 2 of this series focuses on management strategies for TMD. Physical therapy is the preferred conservative management approach for TMD. Physical therapists are professionally well-positioned to step into the void and provide clinical services for patients with TMD. Clinicians should utilize examination findings to design rehabilitation programs that focus on addressing patient-specific impairments. Potentially appropriate plan of care components include joint and soft tissue mobilization, trigger point dry needling, friction massage, therapeutic exercise, patient education, modalities, and outside referral. Management options should address both symptom reduction and oral function. Satisfactory results can often be achieved when management focuses on patient-specific clinical variables.  相似文献   

4.
颞下颌关节紊乱病是由多种因素引起的口腔科常见疾病之一,发病率高,尤见于压力较大的青年人,且此病治疗难、易复发,直接影响到患者的身心健康及生命质量。心理因素已被证明是颞下颌关节紊乱病的发病原因之一,认知行为疗法属于心理学治疗方式的一种,已被应用于精神疾病如抑郁症和焦虑症,以及身体症状如疼痛。认知行为疗法也被应用于口腔科,本文综述了适用于治疗颞下颌关节认知行为疗法的起源、概念形成、理论形成、特点以及认知行为疗法在颞下颌关节紊乱病中的应用,以期为临床提供更多的证据,为患者减少痛苦。  相似文献   

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The overall purpose of this study was to determine whether adolescents with chronic temporomandibular disorder (TMD) pain are more sensitive to all types of somatic and emotional stimuli compared with a matched healthy control group. Sixty adolescents, 8 boys and 52 girls ranging from 12 to 18 years, participated in the study. Thirty of the subjects exhibited TMD, reporting pain of at least 3 months duration. The age- and gender-matched control group consisted of 30 dental recall patients who reported TMD pain less than once a week. All participants completed a 40-item questionnaire comprising 10 items each of pleasant and aversive qualities crossed with somatic and emotional forms of stimuli. The items, a selection of a broad range of familiar stimuli by a panel of experts, were rated based on intensity of experience (0-10, numerical rating scale). Well-fitting items that formed a valid construct within each of the four domains were selected using Rasch analysis. The results showed that adolescents with TMD pain reported significantly greater sensitivity (p<0.05) to aversive somatic and pleasant somatic stimuli than the controls. The differences between groups for the aversive emotional and pleasant emotional stimuli were non-significant. These findings suggest that chronic TMD pain states in adolescents are accompanied by amplification of bodily, but not purely emotional stimuli and that cognitive systems are implicated, not only an alteration of the nociceptive systems.  相似文献   

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8.
Armijo-Olivo SL, Fuentes JP, Major PW, Warren S, Thie NM, Magee DJ. Is maximal strength of the cervical flexor muscles reduced in patients with temporomandibular disorders?

Objective

To determine whether there was a difference in maximal cervical flexor muscle strength in subjects with temporomandibular disorders (mixed and myogenous) compared with healthy subjects.

Design

Cross-sectional study.

Setting

Orthopedics/sports laboratory at the University of Alberta.

Participants

Subjects (N=149) of whom 50 were healthy, 54 had myogenous temporomandibular disorders (TMD), and 45 had mixed TMD.

Interventions

Not applicable.

Main Outcome Measures

Maximal cervical flexor strength, pain.

Results

There was no statistically significant difference in maximal cervical flexor strength among groups (P>.05). Subjects' body weight was significantly associated with strength. No significant association between jaw disability with maximal cervical flexor strength was found. A significant but weak association between neck disability and maximal cervical flexors strength was found.

Conclusions

These results indicated that strength evaluation is one of several assessment factors that need to be addressed when evaluating musculoskeletal painful conditions such as TMD and neck disorders, but strength evaluation cannot be considered as a direct measure of disability. Future studies should explore evaluation of strength in other muscular groups such as cervical extensors, rotators, and lateral flexors, and also under different conditions such as rapid movements, and in patients with more severe jaw disability.  相似文献   

9.
Temporomandibular disorders (TMD) are a heterogeneous group of diagnoses affecting the temporomandibular joint (TMJ) and surrounding tissues. A variety of methods for evaluating and managing TMD have been proposed within the physical therapy profession but these sources are not peer-reviewed and lack updates from scientific literature. The dental profession has provided peer-reviewed sources that lack thoroughness with respect to the neuromusculoskeletal techniques utilized by physical therapists. The subsequent void creates the need for a thorough, research informed, and peer-reviewed source regarding TMD evaluation and management for physical therapists. This paper is the first part in a two-part series that seeks to fill the current void by providing a brief but comprehensive outline for clinicians seeking to provide services for patients with TMD. Part one focuses on anatomy and pathology, arthro- and osteokinematics, epidemiology, history taking, and physical examination as they relate to TMD. An appreciation of the anatomical and mechanical features associated with the TMJ can serve as a foundation for understanding a patient’s clinical presentation. Performance of a thorough patient history and clinical examination can guide the clinician toward an improved diagnostic process.  相似文献   

10.
目的 观察采用关节松动术、运动疗法(前伸辅助开口训练)、红外偏振光理疗治疗不可复性关节盘移位伴张口受限的疗效差别及总结颞下颌关节紊乱病治疗的护理经验。方法 选取60例不可复性关节盘移位伴张口受限患者,抽签分为关节松动术组(A组,n=20)、前伸辅助开口训练组(B组,n=20)、红外偏振光理疗组(C组,n=20),进行相应治疗及临床护理。采用初次治疗前、初次治疗后即刻、治疗3 d后3个时间点的最大开口度来评定临床疗效。结果 初次治疗前,3组最大开口度差异无统计学意义(P>0.05);各组初次治疗后即刻和治疗3 d后,最大开口度较治疗前增加(P<0.05);初次治疗后即刻与治疗3 d后开口度差异无统计学意义(P>0.05)。结论 3种保守治疗方法均可改善不可复性关节盘移位伴张口受限患者的开口度;通过积极、规范、专业的护理,可以为颞下颌关节紊乱病的患者争取良好的预后。  相似文献   

11.
    
A within‐patient change in pain score after treatment is statistically ‘reliable’ when it exceeds the smallest detectable difference (SDD). The aims of the present study were (i) to determine SDD for scoring pain behavior on a 0–5 point adjectival scale, and (ii) to explore the relationship between SDD, clinically important difference (CID) and effect size (ES) following treatment of known efficacy, and to compare these parameters of pain behavior with those of VAS‐scores of pain intensity [van Grootel RJ, van der Bilt A, van der Glas HW. Long‐term reliable change of pain scores in individual myogenous TMD patients. Eur J Pain 2007;11:635–43]. SDD was determined using duplicate scores on pain behavior from a pre‐treatment diary that was completed by 118 patients with myogenous temporomandibular disorders (TMD). CID was determined as the mean change in score following treatment, and Cohen's ES as the ratio between mean change and SD of baseline values. The SDDs were 2–3units (40–60% of the scale range) for test–retest intervals of 1–13 days. CID was 1.13units (22.6%) and ES was 1.38. The normalized SDD and CID values and ES were similar for VAS‐scores of pain intensity, i.e., 38–49% (SDD), 24.2% (CID) and 1.09 (ES). Because reliable change (change>SDD) exceeds CID, the responsiveness of scoring of pain variables is low for detecting CID. The finding of ES values that are larger than 0.5 (ES for patients with chronic degenerative diseases [Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health‐related quality of life. The remarkable universality of half a standard deviation. Med Care 2003;41:582–92]) suggests that for myogenous TMD (chronic pain not caused by somatic disease and with a large chance on recovery following treatment), there are higher expectations of what constitutes important change.  相似文献   

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Our aim was to compare the differences in the prevalence and the anatomical localization of referred pain areas of active trigger points (TrPs) between women with myofascial temporomandibular disorder (TMD) or fibromyalgia (FMS). Twenty women (age 46 ± 8 years) with TMD and 20 (age 48 ± 6 years) with FMS were recruited from specialized clinic. Bilateral temporalis, masseter, sternocleidomastoid, upper trapezius, and suboccipital muscles were examined for TrPs. TrPs were identified by palpation and considered active when the pain reproduced familiar pain symptom experienced by the patient. The referred pain areas were drawn on anatomical maps, digitalized and also measured. A new analysis technique based on a center of gravity (COG) method was used to quantitative estimate of the localization of the TrP referred pain areas. Women with FMS exhibited larger areas of usual pain symptoms than women with myofascial TMD (P < 0.001). The COG coordinates of the usual pain on the frontal and posterior pain maps were located more superior in TMD than in FMS. The number of active TrPs was significantly higher in TMD (mean ± SD 6 ± 1) than in FMS (4 ± 1) (P = 0.002). Women with TMD exhibited more active TrPs in the temporalis and masseter muscles than FMS (P < 0.01). Women with FMS had larger referred pain areas than those with TMD for sternocleidomastoid and suboccipital muscles (P < 0.001). Significant differences within COG coordinates of TrP referred pain areas were found in TMD, the referred pain was more pronounced in the orofacial region, whereas the referred pain in FMS was more pronounced in the cervical spine. This study showed that the referred pain elicited from active TrPs shared similar patterns as usual pain symptoms in women with TMD or FMS, but that distinct differences in TrP prevalence and location of the referred pain areas could be observed. Differences in location of referred pain areas may help clinicians to determine the most relevant TrPs for each pain syndrome in spite of overlaps in pain areas.  相似文献   

14.
    
A within-patient change in pain score after treatment is statistically 'reliable' when it exceeds the smallest detectable difference (SDD). The aims of the present study were to: (i) determine SDDs for VAS-scores of pain intensity, for sufficiently long test-retest intervals to include most biological fluctuations, (ii) examine whether SDD is invariant to baseline score, and (iii) discuss the value of reliable change (RC) for detecting clinically important difference (CID) or as a possible indicator of successful treatment. SDDs were determined using duplicate data from 118 patients with myogenous Temporomandibular disorders: (1) VAS-scores of pain intensity from the masticatory system in a pre-treatment diary, and (2) VAS-scores of pain intensity from the hand (cold-pressor test). RC was determined in VAS-scores from a pre- and post-treatment questionnaire. The long-term SDD was 49mm. A regression analysis on duplicate VAS-scores showed that SDD was largely invariant to the baseline level. Because RC (change>SDD) exceeded CID, it might serve as an indicator of successful treatment. However, only 17% of the patients showed RC after treatment, mainly because the baseline was smaller than SDD in 67% of the patients thus making detection of any treatment effect impossible. For patients with possible detection (33%), the frequency of RC was 51%. If the detection threshold would be avoided by provoking pain in patients with a low baseline, a long-term RC in VAS-scores might occur in about half of all myogenous TMD patients and might then serve as an indicator of cases of treatment success.  相似文献   

15.
下颌神经阻滞结合微波治疗颞颌关节紊乱病   总被引:2,自引:0,他引:2  
目的:了解下颌神经阻滞结合微波治疗颞颌关节紊乱病(简称TMJD)的疗效与安全性。方法:选择诊断明确的单侧TMJD初诊病人50例,随机分成下颌神经阻滞组和对照组(单纯微波组),每组各25例,下颌神经阻滞组行患侧下颌神经阻滞1次/4天,治疗3~5次;配合每日一次局部微波治疗。对照组每日两次局部微波治疗。两组微波治疗均进行15~20天。结果:下颌神经阻滞组治愈16例(64%),好转5例(20%),显效4例(16%),无效0例,平均显效时间1.5±0.8天。对照组治愈10例(40%),好转4例(16%),显效10例(40%),无效1例(4%),平均显效时间6.1±1.3天。半年复发率下颌神经阻滞组4例(16%),对照组13例(52%)。经统计学处理,两组间治愈率和半年复发率有显著性差异(P<0.05)。两组病例均未发现明显不良反应。结论:下颌神经阻滞结合微波能有效提高TMJD的治愈率,缩短显效时间,降低复发率。  相似文献   

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17.
目的:了解颞下颌关节紊乱病患者口腔健康相关生活质量与主观幸福感状况,探讨其生活质量与主观幸福感的相关性。方法:应用口腔健康影响程度量表(OHIP)-14中文版及中国城市居民主观幸福感量表简表对颞下颌关节科就诊的160例颞下颌关节紊乱病患者进行问卷调查,并对调查结果进行分析。结果:颞下颌关节紊乱病患者口腔健康生活质量总分为(14.50±090)分,主观幸福感总分为(85.19±12.66)分;颞下颌关节紊乱病患者口腔健康生活质量总分与主观幸福感总分呈显著负相关,相关系数为-0.632。结论:颞下颌关节紊乱病患者的关节疼痛对生活质量及主观幸福感均造成消极影响,医护人员应在颞下颌关节紊乱病患者就诊时关注其心理状态,在治疗和护理过程中,对影响其生活质量和幸福感的关节疼痛给予特别关注。  相似文献   

18.
Evidence of an effect by botulinum toxins is still lacking for most pain conditions. In the present randomized, placebo-controlled, crossover multicenter study, the efficacy of botulinum toxin type A (BTX-A) was investigated in patients with persistent myofascial temporomandibular disorders (TMD). Twenty-one patients with myofascial TMD without adequate pain relief after conventional treatment participated. A total of 50 U of BTX-A or isotonic saline (control) was randomly injected into 3 standardized sites of the painful masseter muscles. Follow-up was performed after 1 and 3 months, followed by a 1-month washout period, after which crossover occurred. Pain intensity at rest was the primary outcome measure, while physical and emotional function, global improvement, side effects, and clinical measures were additional outcome measures. There was no main difference between drugs (ANOVA; P = .163), but there was a significant time effect (P < .001), so BTX-A reduced mean (SD) percent change of pain intensity by 30 (33%) after 1 month and by 23 (30%) after 3 months compared to 11 (40%) and 4 (33%) for saline. The number of patients who received a 30% pain reduction was not significantly larger for BTX-A than after saline at any follow-up visit. The number needed to treat was 11 after 1 month and 7 after 3 months. There were no significant changes after treatment in any other outcome measures, with the exception of pain on palpation, which decreased 3 months after saline injection (P < .05). These results do not indicate a clinical relevant effect of BTX-A in patients with persistent myofascial TMD pain.  相似文献   

19.
Chronic pain conditions such as fibromyalgia (FM) and temporomandibular disorders (TMDs) are accompanied by complex interactions of cognitive, emotional, and physiological disturbances. Such conditions are complicated and draining to live with, and successful adaptation may depend on ability to self-regulate. Self-regulation involves capacity to exercise control and guide or alter reactions and behavior, abilities essential for human adjustment. Research indicates that self-regulatory strength is a limited source that can be depleted or fatigued, however, and the current study aimed to show that patients with FM and TMD are vulnerable to self-regulatory fatigue as a consequence of their condition. Patients (N = 50) and pain-free matched controls (N = 50) were exposed to an experimental self-regulation task followed by a persistence task. Patients displayed significantly less capacity to persist on the subsequent task compared with controls. In fact, patients exposed to low self-regulatory effort displayed similar low persistence to patients and controls exposed to high self-regulatory effort, indicating that patients with chronic pain conditions may be suffering from chronic self-regulatory fatigue. Baseline heart rate variability, blood glucose, and cortisol predicted persistence, more so for controls than for patients, and more so in the low vs. high self-regulation condition. Impact of chronic pain conditions on self-regulatory effort was mediated by pain, but not by any other factors. The current study suggests that patients with chronic pain conditions likely suffer from chronic self-regulatory fatigue, and underlines the importance of taking self-regulatory capacity into account when aiming to understand and treat these complex conditions.  相似文献   

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