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颞下颌关节紊乱病(temporomandibular disorder,TMD)的病因是多因素的,许多研究表明咬合因素可能有重要意义,但咬合在TMD发病机制中是否起决定性作用仍存在争议。学者设计了动物模型用于探索人工咬合改变的影响。实验性咬合创伤可改变颞下颌关节的血流并导致关节软骨变性;人工咬合干扰诱发了有外周敏化存在的咀嚼肌痛觉反应,且其痛敏的维持亦涉及中枢敏化机制。另一方面,学者们通过设计随机双盲的临床试验,探索咬合干扰能否引发TMD。无TMD病史的受试者能够很好地适应咬合干扰,相反,有TMD病史的受试者则出现明显增多的临床体征,以及程度更强的症状(咬合不适和咀嚼困难);同时,有TMD病史的受试者对人工咬合干扰产生的症状反应似乎也受心理因素的影响,提示对咬合干扰的耐受性的确存在个体差异。虽然咬合干扰的动物模型和临床研究各有优缺点,但两者都是探索咬合对TMD致病机制不可或缺的研究途径。
The etiology of temporomandibular disorder (TMD) is multifactorial. Many studies have suggested that occlusion may be of importance, but the crucial role of occlusion in the pathogenesis of TMD remains controversial. Scholars have designed animal models to explore the effects of changes in artificial bite. Experimental occlusal trauma can change the blood flow of the temporomandibular joint and cause degeneration of articular cartilage. Artificial bite interference induced the chemo-myalgia reaction with peripheral sensitization, and its pain sensitivity was also related to the central sensitization mechanism. On the other hand, scholars have designed a randomized, double-blind clinical trial to explore whether occlusal interference can trigger TMD. Subjects with no history of TMD were able to adapt well to occlusal disturbances. On the contrary, subjects with a history of TMD showed significantly increased clinical signs, as well as more severe symptoms (malaise and chewing difficulties); in the meantime, TMD Symptoms of a subject with a history of artificial bite disturbances also appeared to be influenced by psychological factors, suggesting there was indeed an individual difference in tolerance to bite disturbance. Although animal models and clinical studies of occlusal interference have their own advantages and disadvantages, both are essential to the exploration of the pathogenesis of TMD.