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首页> 外文期刊>National Journal of Maxillofacial Surgery >Outcomes of management of early temporomandibular joint disorders: How effective is nonsurgical therapy in the long-term?
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Outcomes of management of early temporomandibular joint disorders: How effective is nonsurgical therapy in the long-term?

机译：早期颞下颌关节疾病的治疗结果：长期非手术治疗效果如何？

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Aim : The first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes "splint therapy" and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD. Materials and Methods: We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance. Results: One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1-9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex, severity of symptoms and duration of the treatment did not influence treatment results in this group of patients with early TMD. Conclusion: In this population, TMD was significantly higher in females. Treatment of early TMD with IOS was effective and moderately effective in long-term in over 80% of the patients during the follow-up period of 1-9 years. Bruxism had a significant etiologic role in TMD; occlusal attrition of the dentition, pain of all the teeth, early morning pain of the masticatory muscles and the TMJ are signs and symptoms to suspect nocturnal bruxism. Use of an IOS is recommended to prevent potential damage to the dentition, periodontium and the TMJ in early TMD.
机译：目的：治疗颞下颌关节疾病（TMD）的第一步通常是非侵入性的，特别是如果该疾病处于早期阶段。临床上，疼痛和点击是TMD的早期症状。 TMD的管理通常包括“止痛疗法”和止痛药。在这项研究中，我们报告了早期TMD患者的长期治疗结果。材料和方法：我们评估了138名接受TMD治疗的患者的记录。选择的依据是：颞下颌关节（TMJ）的疼痛和/或咔嗒声，TMJ没有病理病变，无复位就没有前盘移位（闭合锁），无退行性关节疾病，无偏头痛，外伤，骨关节炎，代谢史疾病或错牙合（深咬，横咬，下颌畸形等）。患者接受了丙烯酸上颌咬合夹板（IOS）尖顶上升型治疗，并被告知不要咬，打哈欠和咀嚼硬食。评估治疗的结果，潜在的病因（Bruxism），体征和症状以及患者的人口统计学特征（例如年龄，性别，治疗持续时间等）。使用卡方检验分析数据以关联显着性。结果：2001年至2010年，共收治了138例TMD早期症状和体征（TMJ疼痛和/或点击）的患者（男26例，女112例）。女性为81％，男性为19％。 138位患者全部仅在晚上使用IOS。随访1-9年。数据分析表明64％的患者完全缓解了体征和症状; 22％的患者得到了中度缓解（症状和体征的严重性降低），而14％的患者在治疗后没有出现明显的喀哒声或疼痛变化（P = 0.001）。磨牙症患者和同时出现疼痛和点击的患者对IOS治疗表现出更好的反应（分别为P = 0.046和P = 0.001）。结果还表明，年龄，性别，症状的严重程度和治疗持续时间不影响这一组早期TMD患者的治疗结果。结论：在这个人群中，女性的TMD明显更高。在1-9年的随访期内，IOS对早期TMD的治疗在80％以上的患者中长期有效和中度有效。磨牙症在TMD中起重要的病因作用。牙列的咬合损耗，所有牙齿的疼痛，咀嚼肌的清晨疼痛和TMJ是怀疑夜间磨牙症的体征和症状。建议使用IOS，以防止在TMD早期对牙列，牙周膜和TMJ造成潜在损害。

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