应激与颞下颌关节紊乱病研究新进展

颞下颌关节紊乱病是慢性面部疼痛最常见的诱因,常常与躯体和心理主诉症状密切联系,包括疲劳,睡眠失调,焦虑和抑郁等。即使未发现任何能够合理解释疼痛原因的时候,健康专业人士也常常忽略疼痛感受的主观性。从严格的生物医学角度来讲,对疼痛的这种理解是不科学的。本文的主要目的是通过查阅近年来大量的研究文献资料,发现应激引起疼痛感觉的生物学途径以及导致颞下颌关节紊乱的原因。研究发现下丘脑-垂体-肾上腺轴、5-羟色胺和阿片样物质通路都与颌面部疼痛的发病密切相关,同时也提出了未来可能使用的治疗方法。同时,也希望本文能把与疼痛学科差别较大的口腔医学融入到需要多学科合作的颞下颌关节紊乱的诊断和治疗中,从科学角度提高对该病的临床诊疗效率。

Current Status and Perspectives of Researches between Stress and the Temporomandibular Disorders

Temporomandibular disorders（TMD） comprise the most common cause of chronic facial pain conditions,and they are often associated with somatic and psychological complaints including fatigue,sleep disturbances,anxiety,and depression.For many health professionals,the subjectivity of pain experience is frequently neglected even when the clinic does not find any plausible biologic explanation for the pain.This strictly biomedical vision of pain cannot be justified scientifically.The purpose of this study is to demon-strate,by original articles from the literature and recent studies conducted in our own laboratory,the biological processes by which psy-chological stress can be translated into the sensation of pain and contribute to the development of TMD.The role of the hypothalamic-pi-tuitary-adrenal axis,the serotoninergic and opioid systems in the pathogenesis of facial pain is exposed,including possible future thera-peutic approaches.It is hoped that knowledge from apparently disparate fields of dentistry,integrated into a multidisciplinary clinical ap-proach to TMD,will improve diagnosis and treatment for this condition through a clinical practice supported by scientific knowledge.