若年者における顎関節症発症と心理特性に関する２．５年間の前向きコホート調査

• Published in: Journal of the Japanese Society for the Temporomandibular Joint Vol. 20; no. 2; pp. 166 - 173
• Main Authors: ASANO Akiko, TANABE Norimasa, FUJISAWA Masanori
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本顎関節学会 2008; The Japanese Society for Temporomandibular Joint
• Subjects: prospective cohort study; psychological questionnaire; temporomandibular disorder; 前向きコホート調査; 心理テスト; 顎関節症
• ISSN: 0915-3004; 1884-4308
• DOI: 10.11246/gakukansetsu1989.20.166

An investigative joint study to determine the psychological factors contributing to the incidence of temporomandibular disorder (TMD) was conducted on healthy volunteers with no current or past histories of TMD.Since the TMD population mainly consists of patients in their 20s, 207 dental students (139 males and 68 females, mean age 20.4 years) attending Iwate Medical University were involved in this study. Initially, all subjects were asked to fill out a questionnaire screening mandibular functions as well as a psychological questionnaire regarding Y-G, CMI, SDS, MAS and life events and life changes (LeLc). The incidence of TMD symptoms was evaluated 2.5 years later through a self-reported questionnaire.Of 171 subjects who completed the whole examination 2.5 years later, 25 patients (15 males and 10 females) reported experiencing pain in the temporomandibular joint and/or masticatory muscle and/or jaw opening limitation at the 2.5-year follow-up survey.A logistic regression analysis was carried out to determine the basic factors that reveal type B and type E of Y-G, and type I of MAS, respectively. A Mann-Whitney U-test was carried out to determine intrinsic factors that show LeLc. A Kruskal-Wallis test and a Bonferroni correction test were performed, revealing that type B and E of Y-G and type I of MAS had a higher life score than the other types. The results of this study suggest that emotional instability and deep anxiety may be contributing factors that cause TMD, and that patients with TMD suffer greater stress than those who are not physically impaired. 顎関節症発症の寄与因子は, 局所的・身体的因子のほかに, 精神的因子の関与が示唆されている。そこで顎関節症発症の好発年齢である20歳前後を対象に前向きコホート調査を行い, 顎関節症発症の寄与因子を探った。調査対象は岩手医科大学歯学部学生207名 (男性139名, 女性68名, 平均年齢20.4歳) である。調査方法は, 初年度に4種類の心理テスト (Y-G, CMI, SDS, MAS), Life Events・Life Changes質問票 (LeLc), 顎機能に関する質問票調査を施行した。2.5年後に再度顎機能に関する質問票調査を施行し, 顎関節症発症の有無を調査した。2.5年間に追跡調査ができたのは171名 (男性116名, 女性55名) で, そのうち顎関節症を発症したのは25名であった。交絡因子と考えられる性別, 年齢, 関節雑音の影響を排除するためにロジスティック回帰分析を行った結果, Y-GのB, E類, MASの高度な不安とされるI群で有意差が認められた。LeLcの2群間の比較では有意差は認められなかった。各心理テストのライフスコアの平均値の比較では, Y-GのB類とMASのI群で他より有意に高い値を示した。以上の結果から, 情緒不安定, 不安傾向が顎関節症発症の寄与因子となることが示唆された。