臺灣博碩士論文加值系統

一般認為異常咬合以及心理壓力是引起顳顎功能障礙的兩項主要因素。不愉快以及被受壓力的生活經驗似乎較常出現在顳顎功能障礙的患者之中。本研究將探討顳顎功能障礙在青年人中的盛行率，以及與異常咬合，心理壓力人格的相關性。 本研究對南部地區義守大學802名新生進行臨床檢查與問卷調查。本研究採用的問卷題目包含：(1) CES-D 憂鬱量表; (2) Modified Type A 人格量表; (3) Rosenberg self-esteem(RSE) scale 自尊量表; (4) TMD 相關症狀問題。臨床檢查的部分包含口外的視診，觸診與聽診，藉以判定臉部與齒列中線是否對稱；咀嚼肌群是否有酸痛的情形；張閉口時顳顎關節是否有彈響聲。口內的檢查包含牙周組織，齒列的擁擠程度，水平覆蓋(overjet)，垂直覆蓋(overbite)，中線，咬合分類及牙齒磨耗程度等。統計分析主要利用百分比來計算出顳顎功能障礙之盛行率，再利用t檢定、卡方檢定，分析TMD 的盛行率在男女之間有無顯著差異，及與咬合、心理人格特質的相關性。由於TMD屬於複合致病因子所造成的疾病，在比較不同因子對於TMD所造成的影響時，本研究採用對數迴歸分析方法。 本研究顯示盛行率達72.8%。其中男性的盛行率為69.6%，遠低於女性的盛行率78.0%，達統計學上的顯著差異(p=0.0093)。在所有症狀當中以頭頸部疼痛的盛行率為最高(38.6%)，依次為關節彈響(33.0%)，夜間牙關緊咬或磨牙(15.6%)，清晨臉部疼痛或緊繃(8.6%)，白天時牙關緊咬或磨牙(8.1%)，牙關緊閉(5.6%)，最低則為下顎脫臼(4.7%)。就單一個咬合因素來看，中線偏移與顳顎功能障礙具有顯著相關性(p=0.0115)。開咬且具有症狀的比例(87.0%)明顯高於深咬(74.2%)，垂直覆蓋太淺(72.2%)，垂直覆蓋正常(71.7%)，且具有症狀者的比例，但統計上未達顯著差異(p=0.4321)。 在心理因素方面，沒有憂鬱傾向的樣本中，具有顳顎功能障比 例為66.6%。而在輕度憂鬱的樣本中，有症狀的比例為73.9%。中度憂鬱的樣本中，有症狀的比例為82.9%。在重度憂鬱的樣本中，具有症狀的比例高達85.0%。由此可知，隨著憂鬱程度的提高，具有TMD症狀的比例也逐步上升，統計上呈現顯著的相關性(p=0.0002)。 本研究發現在咬合因素方面，只有中線偏移與TMD 具有顯著相關性﹔在心理人格方面，本研究發現憂鬱程度與顳顎功能障礙有顯著相關。若能針對不良咬合以及憂鬱等負面的心理因素予以改善，對於顳顎功能障礙之症狀解除及緩和能有所幫助。 關鍵字: 顳顎功能障礙，心理壓力，異常咬合

It is considered that persons exposed to malocclusion and stress are under increased risk of the occurance and progression of Temporo- mandibular disorders(TMD). Stress and unpleasant life experiences are more frequent in patients with TMD. The aim of this study was to evaluate the prevalence of signs and symptoms of TMD in youths, and the relationship among malocclusion, psychological stress, personality and TMD. There were 802 subjects aged from 17 to 22 years old. Participants received oral examination by three trained dentists and filled out self-report questionnaires. The content of questionnaire was designed to evaluate the degree of TMD, psychological factors (degree of depression) and personality type in the volunteers of this study. The following measures were completed by subjects: 1.Center for Epidemiological Studies Depression Scale (CES-D). 2.Modified Type A Personality Scale. 3.Rosenberg Self-Esteem(RSE) Scale. The oral examination consisted of inspection, palpation, evaluation of occlusion type, overbite, overjet, crowding, midline, periodontal condition, bruxism condition, articular sound. Differences in CES-D scores, occlusal factors, and other categorical variables in subjects with and without TMD were analyzed by use of chi-square test. Logistic regression analysis was used to verify the association between a single explanatory variable and the response variable when controlling for more other explanatory variables. In the examined population of 802 students, the prevalence of TMD was 72.8% (584 subjects). Statistical analysis show a significant higher prevalence of female in TMD group (P=0.0093). The most common symptom of TMD was head/neck pain (38.7%), and followed by clicking sound(33.0%), clenching/bruxism(night)(15.6%), facial pain or stiff -ness(morning)(8.6%), clenching/bruxism(day)(8.1%), trismus(5.6%) and dislocation(4.7%). In the examination of occlusal factors, some type of malocclusion seemed to be associated with TMD. For example, in midline deviation evaluation, the association was statistically significant (p=0.0115). In overbite evaluation, 20 of 23 (87.0%) open bite parti-
cipants exhibited TMD. Although in comparison with other type overbite condition, the association was not statistically significant (p=0.43). In the examination of psychological factors, From the sample of 796 students, 34 of the 40 (85%) severe depression participants, 141 of 170 (82.9%) moderate depression participants, 139 of 188 (73.9%) mild depression participants, and 265 of 398 (66.6%) without depression participants exhibited TMJ dysfunction. The chi-square test revealed that depression (tested by CES-D) and TMD were statistically significantly associated (p=0.0002). Key words: Temporomandibular disorders(TMD), psychological stress, malocclusion.

中文摘要 ------------------------------------------------1
英文摘要 ------------------------------------------------3
第一章 緒論 ---------------------------------------------5
第一節 研究背景
第二節 研究目的
第二章 文獻探討 -----------------------------------------8
第一節 TMD之盛行率
第二節 TMD 與咬合因子的相關性
第三節 TMD與心理壓力及人格精神狀況的相關性
第四節 國內的研究
第三章 材料與方法 --------------------------------------25
第一節 研究對象與方法
第二節 研究步驟與工具
第三節 資料輸入與統計方法
第四章 結果 --------------------------------------------31
第一節 資料收集狀況
第二節 顳顎功能障礙之盛行率
第三節 咬合因子與顳顎功能障礙之相關性
第四節 心理人格特質與顳顎功能障礙之相關性
第五節 對數迴歸分析方法的結果
第五章 討論 --------------------------------------------38
第一節 顳顎功能障礙之盛行率
第二節 咬合因子與顳顎功能障礙之相關性
第三節 心理人格特質與顳顎功能障礙之相關性
第四節 對數迴歸分析方法的結果
第六章 結論 --------------------------------------------52
參考文獻 -----------------------------------------------53
表格目錄 -----------------------------------------------61
附錄 心理人格與顳顎功能障礙問卷量表 --------------------66

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