顎関節症の若年成人における咀嚼行動と咀嚼困難

Masticatory behaviour and chewing difficulties in young adults with temporomandibular disorders.

• Claudia Lúcia Pimenta Ferreira
• Chiarella Sforza
• Francesca M E Rusconi
• Paula Midori Castelo
• Silvana Bommarito

抄録

背景:

咀嚼機能の障害や制限は、顎関節症（TMD）患者が治療を求める主な理由の一つである。

BACKGROUND: Difficulties and limitations on masticatory function are among the main reasons why patients with temporomandibular disorder (TMD) seek care.

目的:

最近発症した軽度の顎関節症を持つ成人の咀嚼行動と咀嚼困難の知覚を、不正咬合の存在を考慮して評価すること。

OBJECTIVE: To evaluate the masticatory behaviour and perception of chewing difficulties in adults with mild TMD of recent onset, considering the presence of malocclusion.

方法:

若年成人81名を、TMDと不正咬合の有無によってグループに分けた。非TMD正常咬合（n=18）、非TMD不正咬合（n=22）、TMD正常咬合（n=18）、TMD不正咬合（n=23）に分けた。顎関節症は顎関節症研究診断基準を用いて評価され、ボランティアは顎の機能制限や異なる食感の食べ物を咀嚼することの難しさについても質問紙に回答した。咀嚼および嚥下行動はOrofacial Myofunctional Evaluation with Scores (OMES)プロトコルを用いて評価した。試験食品を摂取するために要した咀嚼時間と咀嚼回数も得られた。顎関節症、咬合、顎関節症×咬合の相互作用効果を分析するために二元配置ANOVAを用いた。

METHODS: Eighty-one young adults were divided into groups according to the presence of TMD and malocclusion: Non-TMD Normal Occlusion (n = 18), Non-TMD Malocclusion (n = 22), TMD Normal Occlusion (n = 18) and TMD Malocclusion (n = 23). TMD was assessed using the TMD Research Diagnostic Criteria and volunteers also answered questionnaires regarding their perception about jaw functional limitation and difficulty to chew foods of different textures. Masticatory and swallowing behaviours were assessed using the Orofacial Myofunctional Evaluation with Scores (OMES) protocol. Chewing time and chewing frequency taken to ingest the test-food were also obtained. Two-way-ANOVA was used to analyse the TMD, occlusion and TMD × occlusion interaction effects.

結果:

顎関節症の効果は上下顎可動性と顎機能制限の合計スコアに認められ，顎関節症の状態によって開口制限と下顎制限の知覚が異なることを意味し，効果の大きさは中程度であった．また、咀嚼機能（OMES-咀嚼スコア）の変化が多く、咀嚼頻度が高いこともTMDの存在下で観察された（P<0.05）。咬合効果はOMES-咀嚼スコアのみに認められ、TMDと咬合の相互作用効果は認められなかった。

RESULTS: Temporomandibular disorder effect was observed on vertical jaw mobility and jaw function limitation total scores, meaning that groups differed in the perception of opening limitation and mandibular limitation according to TMD status with a medium effect size. Also, more changes in chewing function (OMES-chewing score) and higher chewing frequency was observed in the presence of TMD (P < 0.05). Occlusion effect was only observed on OMES-swallowing score and no TMD × occlusion interaction effect was observed.

結論:

顎関節症の存在下では、咀嚼行動、咀嚼回数、顎関節制限の知覚に変化が見られ、治療計画を立てる際の機能評価の重要性が指摘されました。

CONCLUSION: Changes in chewing behaviour, frequency and perception of mandibular limitation was observed in the presence of TMD, pointing out the importance of functional evaluation when planning and establishing a treatment plan.

© 2019 John Wiley & Sons Ltd.