颞下颌关节紊乱病和咬合异常的关系——从历史到现状

Relationship between temporomandibular disorders and malocclusions: from history to present

关于咬合异常与颞下颌关节紊乱病(temporomandibular disorders,TMD)的关系,从主导病因到仅为局部生物学因素之一,自1980年代以来学术界的认识转变影响到临床诊治行为和研究方向。目前认为TMD致病因素为多因素,咬合因素与TMD的发生关联性较弱,但是有一些共性的咬合异常比如非工作侧[牙合]干扰、最大牙尖交错位和后退接触位之间过度滑动、最大牙尖交错位不稳定等可能是促进TMD发生的危险因素。行为、生物学、环境、社会认知、精神心理等因素的综合作用可以促进TMD症状的发生。在教学和临床工作中不能忽视医源性咬合创伤对促进TMD发生的风险,应重视患者的社会心理环境对疾病的影响,推荐综合治疗方法。

Regarding the relationship between malocclusions and temporomandibular disorders(TMD),from the leading cause to one of the local biological factors,the change in the understanding of the academic community since the 1980s has affected the clinical diagnosis,treatment behavior,and the direction of scientific research.At present,it is believed that the etiology of TMD is multifactor.The occlusal factors and the occurrence of TMD are weakly related,but there are some common malocclusions such as occlusal interference on non-working side,excessive sliding between maximum intercuspid position(MIP)and retruded contact position(RCP),unstable MIP and so on,may be risk factors that promote the disease.The occurrence of TMD symptoms is promoted under the combined action of behavior,biology,environment,social cognition,mentality and other comprehensive factors.In student education and clinical work,the risk of iatrogenic occlusal trauma in promoting the occurrence of TMD cannot be ignored.The impact of the patient′s social and psychological environment on the TMD should be paid attention,and comprehensive treatment strategies is advocated.