Oral sciences reviews最新文献

The potential usefulness of analysis of the salivary secretions in diagnosis and prognosis is beginning to be explored in depth. The preliminary work already undertaken indicates that modern methods applied to this secretion may provide information that is different from that obtained in other body fluids. Saliva is collected at the point of its manufacture and, therefore, is unaffected by collection or storage in the body. It is the product both of protein synthesis within the glands and of most of the known water and electrolyte exchange mechanisms. Salivary composition is affected by both autonomic and hormonal stimuli. As the specific influence of each of these factors is better understood, studies of this fluid will provide important clues to the understanding of disease and the evaluation of therapy. There are few places in the body where it is possible directly, utilizing a non-invasive technique, to examine the product of a large number of important biological processes. It is obvious that careful handling of collection and analytic techniques are essential if these secretions are to be utilized. Future investigations in clinical situations should take full advantage of the strong base of knowledge of the physiology of these glands. Development of this field depends on careful clinical investigations designed to make full use of our current knowledge.

Findings in epidemiologic studies referred to in this review appear to warrant the following conclusions: 1. Symptoms of dysfunction of the masticatory system are very common in unselected materials - much more common than hitherto assumed. This implies that dentists in the future must interest themselves more than hitherto for diagnosis and treatment of functional disturbances of the masticatory system in general practice. 2. There are no differences in frequency of dysfunction between men and women in the general population. Why women dominate in patient materials has not been convincingly explained in the literature. 3. Symptoms of mandibular dysfunction have been found in perons in all age groups. The slight differences as to age distribution reported, indicate more frequent symptoms in old individuals than in young ones. 4. No predominant etiologic factor of dysfunction of the masticatory system has been found in the population studies. Various factors are obviously involved in the etiology of functional disorders. A certain correlation between the degree of dysfunction and the general state of health and the number of residual teeth has, however, been demonstrated. Besides occlusal disturbances and psyhic factors the general health therefore should be observed as an important variable in mandilular dysfunction. 5. In order to faciliate future comparisons between different materials and interpretation of results it is necessary to use the same dignostic criteria and to collect data by reference to suitalbe induces permitting assessment of the prevalence of different symptoms with their severity. 6. With the aid of a generally accepted dysfunction index it should be possible further to elucidate the still many obscure aspects of the etiology and further course of dysfunctional diseases of the masticatory system in clinical materials and population studies. 7. More epidemiologic research of different populations is necessary to increase our knowledge in this field.

On the whole, the studies on GCF have demonstrated that the flow of this fluid is sufficiently indicative of the inflammatory state that it can be used under a variety of clinical conditions to monitor and control gingival inflammation. Since gingivitis is extremely common, and since some cases of gingivitis presumably do not progress to periodontitis, the question could be posed whether or not a concerted effort to control inflammation (i.e. trying to achieve a GCF flow as near to zero as possible) would be clinically significant. Until there is evidence to the contrary, the answer must be "yes", since few cases are known where periodontitis occurs without being preceded by gingivitis. In other words, the control of all gingivitis, if feasible, should prevent most cases of periodontitis. Although control of all gingivitis would mean the treatment of many cases that would not progress to periodontal breakdown, such efforts would be worth-while if most periodontal destruction were prevented. Even the early destructive lesion exhibiting little or no inflammation may soon be identified, mainly because the minute volume of fluid collected from the gingival crevice can now be measured accurately. Accordingly, the concentration of various constituents in the GCF can be determined, which should lead to the development of tests to differentiate between pockets undergoing active destruction with minimal inflammation from the majority of active lesions that are intimately involved with frank inflammation. Thus, a clinician would measure sub-clinical gingival inflammation by measuring GCF flow, then differentiate destructive from quiescent lesions by analyzing the GCF sample for some constituent(s), chemical or microbial (Listgarten et al. 1975) indicative of the periodontal destructive process. Monitoring the flow of GCF might be of value in other clinical situations. For example, one could monitor the response of gingival tissues to various restorative and prosthetic procedures (Strauss et al. 1975) to ensure that these procedures do not aggravate the periodontal tissues and induce gingivitis or periodontitis. The education of the patient should be easier since patients can read their own numbers on the GCF meter at each examination and self-evaluate their personal periodontal condition and the effectiveness of their home care. Even the education of the dental student should be easier since he or she would have the means of self-evaluating the effectiveness of treatment, and not be as dependent upon the subjective assessment of his efforts by an instructor. Finally, monitoring GCF for various components could provide the dentist with a valuable means of easily screening patients for systemic disease. Obviously, this area of investigation is in its infancy, but does promise an exciting future for the oral diagnostician.

1. Although psychological factors are an important etiological component in producing and perpetuating TMJ disorders a comprehensive view of the problem can be best understood through the concept of multifactorial etiology. 2. Psychological factors operative in TMJ disorders cannot be understood within any single frame of reference. It is appropriate to examine emotional, behavioral, and interpersonal relationships in parallel, not as dichotomous concepts. 3. The symptom complex defined in this review as "TMJ disorders" is the musculoskeletal component of a larger group of microtraumatic signs and symptoms, all of which are manifestations of a generalized injury-producing activity termed dysfunction. 4. More explicit diagnoses need to be identified if definitional problems involving TMJ disorders are to be overcome. 5. Classical psychoanalytic conceptualization of the etiology of TMJ disorders has not been systematically examined, but has been widely accepted and found clinically useful by some therapists. 6. Clinical impressions notwithstanding, there is little evidence to indicate that TMJ disorders are correlated with one specific personality trait. Perhaps more definitive assessments will reveal uniform personality characteristics in subclasses of TMJ patients. 7. Emotional factors (e.g., anxiety, fear, frustration, and anger) play a significant role in the etiology of TMJ disorders, in that they elicit muscular tension and oral habits. Although it would appear unlikely that emotionally induced muscle activity is a "necessary" factor, it is probable that it will be found a "sufficient" cause for TMJ disorders. 8. Learning principles, should not be considered as an alternative etiological position but should be viewed as a framework upon which any psychological theory of etiology must be based. 9. The presence of chronic pain in TMJ patients may be of as much clinical significance in the prognosis as the physical findings associated with the disorder itself. 10. The potential placebo effect resulting from any treatment, coupled with other nonspecific effects of the doctor's attitudes, remains a powerful tool that can be utilized in treating TMJ disorders. A vital ingredient in the placebo effect is the quality of the doctor-patient relationship. 11. Patient evaluation should not only include a) a search for the immediate organic stimulus or biomechanical disturbance, but also b) an assessment of situational or chronic anxiety and other emotional factors and c) an observation of interpersonal styles of behavior commonly associated with the chronically sick patient. 12. Unilateral etiological views of TMJ disorders and rigid treatment approaches need modification. Treatment involving simultaneous dental and psychological approaches appears to have more promise.