牙科患者對顳顎關節疾病之認知及現況調查

研究背景：　　目前國內外許多有關顳顎關節疾病(TMD)的流行病學研究已經完成，包括年齡層、性別等各方面所進行的橫斷面研究，及各種常見症狀之盛行率、病因探討等，有關患者對顳顎關節疾病之認知，卻付之闕如。研究目的：　　本研究主要是調查牙科患者對顳顎關節疾病之認知程度，並探討認知程度與哪些因素有相關性，也調查了牙科患者在產生與顳顎關節疾病相關的症狀時，所選擇的就醫行為，及其產生與顳顎關節疾病相關之症狀的發生率；並分析比較被懷疑患有顳顎關節疾病者與無顳顎關節疾病者的口腔狀況，並探討與顳顎關節疾病有關的危險因子。研究方法：　　研究對象為2003年9月至2004年2月的六個月期間，至高雄市二所牙科診所就診之18歲以上患者，共計樣本數有316人(男生121人和女生195人)。研究工具為一份自行設計之『自覺式回憶性問卷』；問卷內容包含兩部分，第一部分為基本資料，由牙科初診患者自行填寫，第二部分為臨床部分，由牙醫師進行口腔狀況的檢查。結果：　　牙科患者對『顳顎關節疾病』的認知比例為17.72%，女性的認知比例顯著地高於男性；年齡層越低者其認知比例越高，但未達統計上顯著性差異。耳朵前方疼痛、張閉口時耳朵附近有聲響，均以看耳鼻喉科最多，牙科次之；觸壓臉頰會痛、牙齒咬緊時會痛、吃東西時張口有困難，及夜間磨牙想治療以看牙科最多。　　『半年內有頭頸部疼痛或偏頭痛』的盛行率為女性(45.64%)顯著地遠高於男性(27.27%) ；『夜間磨牙』的盛行率則是男性(20.66%)顯著地高於女性(12.31%)。懷疑患有TMD的患者佔了23.73%，女性的罹患率略高於男性，且TMD的罹患率隨著年齡增加而減少。　　就口內情形而言，在兩頷前突、開咬、後牙支持喪失等三項，懷疑患有TMD者之發生率，均略高於無TMD者。懷疑患有TMD者其『關節雜音』的發生率，顯著地高於無TMD者。　　『咬緊牙關』、『壓力』，與『情緒緊張或沮喪』，和是否罹患TMD間達統計上顯著性差異，即出現這三種情況的患者被懷疑患有TMD的機率，顯著地高於沒有這三種情況的患者。結論：　　本研究發現牙科患者對於『顳顎關節疾病』的認知比例為17.72%，且女性的認知比例顯著地高於男性；而被懷疑患有TMD的患者佔23.73%，女性略高於男性。咬合情況和TMD之間僅具有微弱的相關性，而非直接導致顳顎關節疾病的重要因子，此外，TMD與壓力及情緒的高相關性非常顯著。

關鍵字

認知；顳顎關節疾病；自覺式回憶性問卷

並列摘要

Background： Numerous epidemiologic studies of temporomandibular disorders (TMD) had been completed at present, including cross-sectional studies about age groups, gender, the prevalence of common symptoms, and etiology of TMD. However, there were limited studies on the perception of TMD of patients. Purpose： The perception of TMD of dental patients and which factors were associated with the perception were investigated. We also investigated the medical visit behavior of dental patients when they had some TMD- related symptoms of them. At last, we compared the oral condition of suspect TMD patients with non-TMD patients, and risk factors in relation to TMD. Methods： The subjects comprised 316 patients(121 men and 195 women) aged above 18 years from two local dental clinics in Kaohsiung City during September, 2003 to February, 2004. A self-anamnestic question- naire was used in our study. The questionnaire contained information about personal and medical history completed by new dental patients and clinical examinations evaluated by the dentists. Results： The perception of TMD of dental patients was 17.72%, and women’s perception ratio was better than men’s. The younger age group, the better perception ratio, but there was no statistically significance between age groups. As for medical visit behavior, if patients had pain in front of ears and noises while opening or closing mouth, they would mostly frequently come to ENT, followed by dentistry. If patients had facial tenderness, pain while clenching, and felt difficult to open mouth while eating, and wanted to have their nocturnal bruxism been treated, they would most frequently come to dentistry. The prevalence of “pain over head and neck or migraine during the past six months” of women(45.64%) was significantly higher than men’s (27.27%). The prevalence of “noctural bruxism” of men(20.66%) was significantly higher than women’s(12.31%). The prevalence of suspect TMD patients was 23.73%, and was found higher in women than men. The prevalence of TMD was decreased with age in the present study. The oral condition of bimaxillary protrusion, open bite, and vertical stop loss were more common in suspect TMD patients than in non-TMD patients. The incidence of “TMJ noises” of suspect TMD patients was significantly higher than non-TMD patients. “Clenching” , “stress”, “tension and depression” showed statisti- cally significant difference with TMD. On the other hand, the opportunity of suspected TMD of patients with these three conditions was signifi- cantly higher than patients without these three conditions. Conclusions： The perception of TMD of dental patients was 17.72%, and women’s perception ratio was better than men’s. The prevalence of suspect TMD patients was 23.73%, and was found higher in women than men. The relationship between occlusion and TMD only revealed weak correlation, and occlusion was not an important factor that precipitates TMD. In additional, the strong correlations between TMD with stress and emotion were very significant.