颞下颌关节病的病因问题:咬合因素的流行病学和病因学依据

The dental occlusion as a suspected cause for TMDs: epidemiological and etiological considerations

咬合与颞下颌关节紊乱病(temporomandibular disorders,TMD)的关系是口腔医学领域最有争议的问题。一项大样本流行病学横断面研究(德国Pomerania地区的健康调查)发现,有15项咬合相关的指标与TMD症状、体征相关。另外一些研究也报道其他与TMD有关的咬合指标。然而,统计学研究结果并不支持这些指标与TMD之间的因果关系,用Hill 9项病因学标准评价,结果显示咬合因素与TMD之间的因果关系很弱,只有磨牙症、后牙缺失和单侧后牙反□在多项研究的结果中表现出一定的一致性,而且有证据显示,一些报道中的咬合表现可能是TMD的结果而不是病因。总之,咬合病因学的生物学证据通常很难得到,女性比男性易发TMD,□板或咬合调整虽然可以缓解症状,但不能排除颌间关系改变所产生的作用,而且TMD症状不经过治疗也可缓解。有TMD病史的患者可能更易再次出现TMD,因此关注那些已知的非咬合因素可能更有助于了解TMD的易感性、始动因素(诱因)或者持续发挥作用的因素。

The relationship between the dental occlusion and temporomandibular disorders （TMDs）has been one of the most controversial topics in the dental community.In a large epidemiological cross-sectional survey-the Study of Health in Pomerania （Germany）-associations between 1 5 occlusion-related variables and TMD signs or symptoms were found.In other investigations,additional occlusal variables were i-dentified.However,statistical associations do not prove causality.By using Hill＆#39;s nine criteria of causation,it becomes apparent that the evi-dence of a causal relationship is weak.Only bruxism,loss of posterior support and unilateral posterior crossbite show some consistency across studies.On the other hand,several reported occlusal features appear to be the consequence of TMDs,not their cause.Above all,however, biological plausibility for an occlusal aetiology is often difficult to establish,because TMDs are much more common among women than men. Symptom improvement after insertion of an oral splint or after occlusal adjustment does not prove an occlusal aetiology either,because the a-melioration may be due to the change of the appliance-induced intermaxillary relationship.In addition,symptoms often abate even in the ab-sence of therapy.Although patients with a TMD history might have a specific risk for developing TMD signs,it appears more rewarding to fo-cus on non-occlusal features that are known to have a potential for the predisposition,initiation or perpetuation of TMDs.