顎関節症診断における顎関節疼痛誘発テストの妥当性  [in Japanese] Validity of the Stick-Biting Test for Diagnosis of Patients with Temporomandibular Disorders  [in Japanese]

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Author(s)

    • 重田 優子 SHIGETA Yuhko
    • 鶴見大学歯学部歯科補綴学第2講座 Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine
    • 小川 匠 OGAWA Takumi
    • 鶴見大学歯学部歯科補綴学第2講座 Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine
    • 平井 真也 HIRAI Shinya
    • 鶴見大学歯学部歯科補綴学第2講座 Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine
    • 近藤 壽郎 KONDOH Toshirou
    • 鶴見大学歯学部口腔外科学第1講座 First Department of Oral and Maxillofacial Surgery, Tsurumi University School of Dental Medicine
    • 福島 俊士 FUKUSHIMA Shunji
    • 鶴見大学歯学部歯科補綴学第2講座 Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine

Abstract

目的: この研究では, 顎関節症患者に顎関節疼痛誘発テストを応用し, その反応を臨床診査時の疼痛所見および関節円板の状態と比較した. 本研究の目的は, このテストの有痛性の円板転位に対する診断精度を明らかにすることである.<BR>方法: 対象は本学補綴科あるいは口腔外科を受診し, 顎関節症と診断された患者で, 本研究の趣旨に賛同の得られた47名である. 患者の上下顎第二大臼歯間にプラスチック棒 (厚さ9mm) を介在して片側性に噛みしめさせ, そのときの誘発痛の有無, その部位を記録した. また, これらの知見を同患者の臨床症状およびMRI所見と比較した. すなわち, すべての顎関節を関節円板の状態と診査時の顎関節部の疼痛の有無により関節円板転位なし (N), 無痛性の円板転位 (NP-Dis), 有痛性の円板転位 (PDis) の3群に分類し, 誘発痛との関連性について検討した.<BR>結果: 顎関節疼痛誘発テストによる非噛みしめ側の疼痛は主に顎関節部にみられ, その多くで当該関節に有痛性の円板転位がみられた. 顎関節疼痛誘発テストの有痛性の円板転位症例に対する診断精度は有効度83%, 感度71%, 特異度89%, 陽性反応適中率76%, 陰性反応適中率86%であった.<BR>結論: 顎関節疼痛誘発テストの有痛性の円板転位に対する診断精度は高く, 臨床的に有用であることが示唆された.

Purpose: In this study, the stick-biting test was applied to temporomandibular disorders (TMD) patients, and the responses were compared with disc conditions combined with pain at clinical examination. The purpose of this study was to clarify the diagnostic accuracy of this test for diagnosing disc displacement with pain at clinical examination.<BR>Methods: Subjects were selected from patients who visited either the prosthetic or the oral and maxillofacial departments at Tsurumi University Dental Hospital and were diagnosed as having TMD. They were asked to clench unilaterally on a plastic stick (about 9mm thick) placed at the most posterior portion on the dentition. Then, the site and amount of evoked pain were recorded. Those findings were related to MRI findings combined with pain at clinical examination; that is, no disc displacement (N), disc displacement without pain (NP-Dis), and disc displacement with pain (PDis).<BR>Results: Pain on the non-clenching side was mostly evoked at the TMJ region, and their disc conditions were chiefly in P-Dis. The diagnostic accuracy of this test for this phenomenon was: efficiency, 83%; sensitivity, 71%; specificity, 89%; positive predictive value, 76%, and negative predictive value, 86%.<BR>Conclusions: It was suggested that pain in the contralateral-side TMJ region during the stick-biting test was useful to clinically identify painful disc displacement at clinical examination with high diagnostic accuracy.

Journal

  • Nihon Hotetsu Shika Gakkai Zasshi

    Nihon Hotetsu Shika Gakkai Zasshi 45(4), 486-493, 2001-08-10

    Japan Prosthodontic Society

References:  35

Codes

  • NII Article ID (NAID)
    10008629948
  • NII NACSIS-CAT ID (NCID)
    AN00197911
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    03895386
  • Data Source
    CJP  J-STAGE 
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