顎関節症患者の臨床症状に対する咀嚼筋痛，顎関節円板動態異常，変形性顎関節症の相対的影響度
本研究は，顎関節円板転位の状態，咀嚼筋痛の存在，変形性顎関節症（OA）の存在が患者の主観的疼痛強度および日常生活支障度に与える相対的な影響度を検討することを目的とした。被験者は顎関節症症状を有する患者393名を対象とした。関節円板動態異常およびOAはMRI検査により診断した。また，触診により咀嚼筋の圧痛を記録した。安静時の痛みおよび咀嚼時の痛みはvisual analog scaleを使用して記録し，日常生活支障度は日常生活動作尺度（ADL）を用いて評価した。統計解析は，従属変数を安静時の痛み，咀嚼時の痛み，ADLとし，それぞれの重回帰分析を実施した。説明変数は年齢，性別，咀嚼筋痛の有無，関節...
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| Published in | 日本顎関節学会雑誌 Vol. 33; no. 2; pp. 37 - 44 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本顎関節学会
20.08.2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0915-3004 1884-4308 |
| DOI | 10.11246/gakukansetsu.33.37 |
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| Abstract | 本研究は，顎関節円板転位の状態，咀嚼筋痛の存在，変形性顎関節症（OA）の存在が患者の主観的疼痛強度および日常生活支障度に与える相対的な影響度を検討することを目的とした。被験者は顎関節症症状を有する患者393名を対象とした。関節円板動態異常およびOAはMRI検査により診断した。また，触診により咀嚼筋の圧痛を記録した。安静時の痛みおよび咀嚼時の痛みはvisual analog scaleを使用して記録し，日常生活支障度は日常生活動作尺度（ADL）を用いて評価した。統計解析は，従属変数を安静時の痛み，咀嚼時の痛み，ADLとし，それぞれの重回帰分析を実施した。説明変数は年齢，性別，咀嚼筋痛の有無，関節円板の動態異常の分類，OAの有無とし，強制投入法を用いた。安静時の痛みを従属変数とした重回帰分析の結果，年齢（p=0.008）および咀嚼筋痛の存在（p＜0.001）が統計学的に有意な説明変数であった。咀嚼時の痛みを従属変数とした重回帰分析の結果，年齢（p=0.034）および咀嚼筋痛の存在（p＜0.001）が統計学的に有意な説明変数であった。ADLを従属変数とした重回帰分析の結果，咀嚼筋痛の存在が統計学的に有意な説明変数であった（p＜0.001）。以上の結果から，関節円板の状態異常やOAの存在より，咀嚼筋痛の存在が顎関節症患者の臨床症状に与える影響が大きいことが明らかとなり，咀嚼筋痛の改善が優先的な治療目標となる可能性が示唆された。 |
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| AbstractList | 本研究は，顎関節円板転位の状態，咀嚼筋痛の存在，変形性顎関節症（OA）の存在が患者の主観的疼痛強度および日常生活支障度に与える相対的な影響度を検討することを目的とした。被験者は顎関節症症状を有する患者393名を対象とした。関節円板動態異常およびOAはMRI検査により診断した。また，触診により咀嚼筋の圧痛を記録した。安静時の痛みおよび咀嚼時の痛みはvisual analog scaleを使用して記録し，日常生活支障度は日常生活動作尺度（ADL）を用いて評価した。統計解析は，従属変数を安静時の痛み，咀嚼時の痛み，ADLとし，それぞれの重回帰分析を実施した。説明変数は年齢，性別，咀嚼筋痛の有無，関節円板の動態異常の分類，OAの有無とし，強制投入法を用いた。安静時の痛みを従属変数とした重回帰分析の結果，年齢（p=0.008）および咀嚼筋痛の存在（p＜0.001）が統計学的に有意な説明変数であった。咀嚼時の痛みを従属変数とした重回帰分析の結果，年齢（p=0.034）および咀嚼筋痛の存在（p＜0.001）が統計学的に有意な説明変数であった。ADLを従属変数とした重回帰分析の結果，咀嚼筋痛の存在が統計学的に有意な説明変数であった（p＜0.001）。以上の結果から，関節円板の状態異常やOAの存在より，咀嚼筋痛の存在が顎関節症患者の臨床症状に与える影響が大きいことが明らかとなり，咀嚼筋痛の改善が優先的な治療目標となる可能性が示唆された。 |
| Author | 髙岡, 亮太 島本, 博彰 久山, 晃太郎 森口, 大輔 石垣, 尚一 中谷, 温紀 内山, 百夏 矢谷, 博文 |
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| References | 20) Schiffman EL, Ohrbach R, Truelove EL, Tai F, Anderson GC, Pan W, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. V: Methods used to establish and validate revised Axis I diagnostic algorithms. J Orofac Pain 2010; 24: 63-78. 2) Gil-Martínez A, Grande-Alonso M, López-de-Uralde-Villanueva I, López-López A, Fernández-Carnero J, La Touche R. Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement. J Headache Pain 2016; 17: 103. 8) Milano V, Desiate A, Bellino R, Garofalo T. Magnetic resonance imaging of temporomandibular disorders: classification, prevalence and interpretation of disc displacement and deformation. Dentomaxillofac Radiol 2000; 29: 352-61. 12) Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R, et al. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J Pain 2013; 14 (12 Suppl): T75-90. 9) Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844-60. 17) Tonin RH, Iwaki Filho L, Grossmann E, Lazarin RO, Pinto GN, Previdelli IT, et al. Correlation between age, gender, and the number of diagnoses of temporomandibular disorders through magnetic resonance imaging: A retrospective observational study. Cranio 2018; 1-9. 22) Schiffman EL, Velly AM, Look JO, Hodges JS, Swift JQ, Decker KL, et al. Effects of four treatment strategies for temporomandibular joint closed lock. Int J Oral Maxillofac Surg 2014; 43: 217-26. 11) Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful temporomandibular disorder: Decade of discovery from OPPERA studies. J Dent Res 2016; 95: 1084-92. 23) Chen YJ, Shih TT, Wang JS, Wang HY, Shiau YY. Magnetic resonance images of the temporomandibular joints of patients with acquired open bite. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99: 734-42. 3) Emshoff R, Brandlmaier I, Gerhard S, Strobl H, Bertram S, Rudisch A. Magnetic resonance imaging predictors of temporomandibular joint pain. J Am Dent Assoc 2003; 134: 705-14. 6) Katzberg RW, Westesson PL, Tallents RH, Kurita K, Manzione JV, Totterman S. Temporomandibular joint: MR assessment of rotational and sideways disk displacements. Radiology 1988; 169: 741-8. 15) Pullinger AG, Seligman DA, Gornbein JA. A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features. J Dent Res 1993; 72: 968-79. 7) Foucart JM, Carpentier P, Pajoni D, Marguelles-Bonnet R, Pharaboz C. MR of 732 TMJs: anterior, rotational, partial and sideways disc displacements. Eur J Radiol 1998; 28: 86-94. 10) Minakuchi H, Kuboki T, Matsuka Y, Maekawa K, Yatani H, Yamashita A. Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction. J Dent Res 2001; 80: 924-8. 14) Mohlin B, Axelsson S, Paulin G, Pietillä T, Bondemark L, Brattström V, et al. TMD in relation to malocclusion and orthodontic treatment. Angle Orthod 2007; 77: 542-8. 4) Manfredini D, Marini M, Pavan C, Pavan L, Guarda-Nardini L. Psychosocial profiles of painful TMD patients. J Oral Rehabil 2009; 36: 193-8. 18) Kino K, Sugisaki M, Haketa T, Amemori Y, Ishikawa T, Shibuya T, et al. The comparison between pains, difficulties in function, and associating factors of patients in subtypes of temporomandibular disorders. J Oral Rehabil 2005; 32: 315-25. 21) Chantaracherd P, John MT, Hodges JS, Schiffman EL. Temporomandibular joint disorders' impact on pain, function, and disability. J Dent Res 2015; 94 (3 Suppl): 79s-86s. 5) Westesson PL, Larheim TA, Tanaka H. Posterior disc displacement in the temporomandibular joint. J Oral Maxillofac Surg 1998; 56: 1266-73; discussion 1273-1274. 13) Jordani PC, Campi LB, Circeli GZ, Visscher CM, Bigal ME, Goncalves DA. Obesity as a risk factor for temporomandibular disorders. J Oral Rehabil 2017; 44: 1-8. 1) Reissmann DR, John MT, Schierz O, Wassell RW. Functional and psychosocial impact related to specific temporomandibular disorder diagnoses. J Dent 2007; 35: 643-50. 16) Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: e26-50. 19) Misch CE. Divisions of available bone in implant dentistry. Int J Oral Implantol 1990; 7: 9-17. |
| References_xml | – reference: 10) Minakuchi H, Kuboki T, Matsuka Y, Maekawa K, Yatani H, Yamashita A. Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction. J Dent Res 2001; 80: 924-8. – reference: 1) Reissmann DR, John MT, Schierz O, Wassell RW. Functional and psychosocial impact related to specific temporomandibular disorder diagnoses. J Dent 2007; 35: 643-50. – reference: 20) Schiffman EL, Ohrbach R, Truelove EL, Tai F, Anderson GC, Pan W, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. V: Methods used to establish and validate revised Axis I diagnostic algorithms. J Orofac Pain 2010; 24: 63-78. – reference: 7) Foucart JM, Carpentier P, Pajoni D, Marguelles-Bonnet R, Pharaboz C. MR of 732 TMJs: anterior, rotational, partial and sideways disc displacements. Eur J Radiol 1998; 28: 86-94. – reference: 16) Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: e26-50. – reference: 11) Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful temporomandibular disorder: Decade of discovery from OPPERA studies. J Dent Res 2016; 95: 1084-92. – reference: 21) Chantaracherd P, John MT, Hodges JS, Schiffman EL. Temporomandibular joint disorders' impact on pain, function, and disability. J Dent Res 2015; 94 (3 Suppl): 79s-86s. – reference: 15) Pullinger AG, Seligman DA, Gornbein JA. A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features. J Dent Res 1993; 72: 968-79. – reference: 19) Misch CE. Divisions of available bone in implant dentistry. Int J Oral Implantol 1990; 7: 9-17. – reference: 22) Schiffman EL, Velly AM, Look JO, Hodges JS, Swift JQ, Decker KL, et al. Effects of four treatment strategies for temporomandibular joint closed lock. Int J Oral Maxillofac Surg 2014; 43: 217-26. – reference: 6) Katzberg RW, Westesson PL, Tallents RH, Kurita K, Manzione JV, Totterman S. Temporomandibular joint: MR assessment of rotational and sideways disk displacements. Radiology 1988; 169: 741-8. – reference: 4) Manfredini D, Marini M, Pavan C, Pavan L, Guarda-Nardini L. Psychosocial profiles of painful TMD patients. J Oral Rehabil 2009; 36: 193-8. – reference: 5) Westesson PL, Larheim TA, Tanaka H. Posterior disc displacement in the temporomandibular joint. J Oral Maxillofac Surg 1998; 56: 1266-73; discussion 1273-1274. – reference: 8) Milano V, Desiate A, Bellino R, Garofalo T. Magnetic resonance imaging of temporomandibular disorders: classification, prevalence and interpretation of disc displacement and deformation. Dentomaxillofac Radiol 2000; 29: 352-61. – reference: 2) Gil-Martínez A, Grande-Alonso M, López-de-Uralde-Villanueva I, López-López A, Fernández-Carnero J, La Touche R. Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement. J Headache Pain 2016; 17: 103. – reference: 9) Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844-60. – reference: 13) Jordani PC, Campi LB, Circeli GZ, Visscher CM, Bigal ME, Goncalves DA. Obesity as a risk factor for temporomandibular disorders. J Oral Rehabil 2017; 44: 1-8. – reference: 18) Kino K, Sugisaki M, Haketa T, Amemori Y, Ishikawa T, Shibuya T, et al. The comparison between pains, difficulties in function, and associating factors of patients in subtypes of temporomandibular disorders. J Oral Rehabil 2005; 32: 315-25. – reference: 14) Mohlin B, Axelsson S, Paulin G, Pietillä T, Bondemark L, Brattström V, et al. TMD in relation to malocclusion and orthodontic treatment. Angle Orthod 2007; 77: 542-8. – reference: 23) Chen YJ, Shih TT, Wang JS, Wang HY, Shiau YY. Magnetic resonance images of the temporomandibular joints of patients with acquired open bite. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99: 734-42. – reference: 17) Tonin RH, Iwaki Filho L, Grossmann E, Lazarin RO, Pinto GN, Previdelli IT, et al. Correlation between age, gender, and the number of diagnoses of temporomandibular disorders through magnetic resonance imaging: A retrospective observational study. Cranio 2018; 1-9. – reference: 3) Emshoff R, Brandlmaier I, Gerhard S, Strobl H, Bertram S, Rudisch A. Magnetic resonance imaging predictors of temporomandibular joint pain. J Am Dent Assoc 2003; 134: 705-14. – reference: 12) Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R, et al. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J Pain 2013; 14 (12 Suppl): T75-90. |
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| SubjectTerms | 咀嚼筋痛 変形性顎関節症 多変量解析 顎関節円板転位 |
| Title | 顎関節症患者の臨床症状に対する咀嚼筋痛，顎関節円板動態異常，変形性顎関節症の相対的影響度 |
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