- 學位論文
學齡前兒童顳顎關節功能不良之盛行率
The prevalence of temporomandibular joint dysfunction in preschool children
摘要
長久以來顳顎關節功能不良 (temporomandibular joint dysfunction，簡稱TMD) 一直都是牙醫師熱烈探討的問題，但在學齡前兒童方面則少有這類的文獻討論，因此本研究將針對學齡前兒童進行顳顎關節功能不良之盛行率調查，並進一步探討TMD與咬合(occlusion) 及口腔不良習癖(oral parafunction)之相關性，以期能找出可能造成兒童顳顎關節功能不良之促成因子。 本研究於高雄市的幼稚園中，隨機抽樣485位4~6歲之學齡前兒童進行問卷及臨床檢查(其中排除不合作、家長不願配合或身心障礙之兒童)。由四位有臨床經驗之牙醫師進行問卷及臨床檢查，問卷包括：個人基本資料及病史，口腔不良習癖，任何頭頸、顏面部之疼痛；口外臨床檢查的部分包括：顳顎關節聲響，下顎移動的狀況，是否有肌肉之觸痛，臉部外形是否不對稱，側面觀，下顎的位置；口內臨床檢查的部分包括：中線是否偏移，最大張口度，咬合狀況(包括是否有深咬、開咬或錯咬的現象)，以及口內牙齒狀況。 資料收集後，將有顳顎關節聲響、咀嚼時肌肉關節處疼痛、張口閉口時肌肉關節處疼痛，或下顎移動路徑偏移以上任何一項徵象與症狀者，認定為有顳顎關節功能不良之臨床症狀，再以t檢定及卡方檢定進行統計分析。 經分析後發現學齡前兒童顳顎關節功能不良之盛行率為18.35%，在男童(17.43%)與女童(19.26%)之間並無顯著差異。 在口腔不良習癖方面， 4-6歲的兒童中，吸手指的盛行率最高(21.86%)，其次是咬指甲 (20.82%)，再來是咬嘴唇(5.77%)，磨牙(1.44%)及舌前推(1.03%)則較少發生。其盛行率在男女之間並無顯著差異，且各項口腔不良習癖與顳顎關節功能不良之間亦無顯著相關。 在異常咬合方面，男女之間並無統計學上的顯著相關，但深咬(15.88%)及後牙錯咬(2.06%)分別與顳顎關節功能不良有顯著相關性(p=0.0115，p=0.0004)，開咬(1.86%)與前牙錯咬(12.37%)則沒有顯著相關。 由上可知，顳顎關節功能不良之症狀與徵象確實存在於學齡前兒童，且深咬以及後牙錯咬與顳顎關節功能不良有顯著相關性，因此在兒童的口腔檢查方面，顳顎關節相關檢查應予以重視，此外對於早期的咬合不良若能即早發現並予以治療，應當對顳顎關節之發育及功能有所幫助。
並列摘要
Temporomandibular joint dysfunction (TMD) is now an extremely well-known clinical disorder in adults, but relatively little information is available in children. The aim of this study was to investigate the prevalence of TMD in Taiwanese preschool children, and the relationship between oral parafunction, occlusion and TMD. The presence of signs and symptoms (S/S) of TMD in 485 children (aged 4-6 years old) was evaluated through a questionnaire and clinical examination. The questionnaire consisted of personal history, oral parafunctions and the pain history of the stomatognathic system. The extraoral examination included TMJ sounds, mandibular movement, and muscle tenderness; the intraoral examination included teeth status and maximum mouth opening. The occlusal relationship containing deep bite, cross bite and open bite were also recorded. The prevalence of TMD was 18.35% and there’s no significant sex difference (p=0.6017). The most common S/S of TMD was TMJ sounds (16.7%), and followed by headache (6.19%) and mandibular deviation (3.3%). The most common oral parafunction were thumb/finger sucking (21.86%) and nail biting (20.82%), and followed by lip biting (5.77%), bruxism (1.44%) and tongue thrusting (1.03%). There’s no significant association between TMD and oral parafunction. On the other hand, deep bite (15.88%) and posterior cross bite (2.06%) were significantly associated with TMD (p=0.0115, p=0.0004), but open bite (1.86%) and anterior cross bite (12.37%) did not. We concluded that S/S of TMD were indeed present in early ages, and TMD was associated with open bite and posterior cross bite. The importance of TMJ examination and malocclusion of the pediatric patient should be paid attention to.