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Contribution of a Practical Trial Chart for the Health Condition ofthe Temporomandibular Joint to the Promoting of the Oral Healthof Students in High School and Junior High School
1Division of Oral Health & Preventive Dentistry, Department of Community Health Sciences, Meikai University, School of Dentistry2Division of Special Care Dentistry, Department of Community Health Sciences, Meikai University, School of Dentistry
3Division of Sports Dentistry, Department of Community Health Sciences, Meikai University, School of Dentistry
Table 1 Questions in the health chart of temporomandibular joint(TMJ).
〈The health history of temporomandibular joint(TMJ)or temporomandibular disorder(TMD)〉・Have you been diagnosed with TMJ derangement or TMD? How long have you been diagnosed with it?・Have you been treated for TMJ derangement or TMD? How long have you been treated for it?・Have you had jaw pain or some other symptom(s)due to TMJ derangement or TMD? If so, how long?
〈TMJ chart①〉○Jaw pain・Do you have pressure-induced pain on pressure at ①, ②, or ③・Do you have pressure-induced pain on pressure at ①?(Masseter muscle)・Do you have pressure-induced pain on pressure at ②?(Temporal muscle)・Do you have pressure-induced pain on pressure at ③?(Stemocleidomastoid muscle)・Do you have jaw pain when your mouth is open?・Do you have jaw pain while clenching your teeth?・Do you have jaw pain while moving your mouth?○Dysfunction of the jaw mouvement・Do you feel difficulty in opening your mouth?・Are you able to open your mouth in no more than 40 mm?・Do you feel that your mouth dose not open evenly?○TMJ noise・Do you hear noise from the jaw joint(s)the sound of“kokukoku”,“gakugaku”(clicking noise)?(“Kokukoku”and“gakugaku”are onomatopoeia in Japanese)・Do you hear noise from the jaw joint(s) the sound of“gorigori”,“zarizari”(crepitus noise)?(“Gorigori”and“zarizari”are onomatopoeia in Japanese)
〈TMJ chart②〉○Health condition of teeth and mouth・Do you have“summer”teeth(malalignment and/or malocclusion of teeth)?・Do you have any untreated cavity(dental caries)?・As a child, have you many decayed teeth?・Have you ever hit your jaw or chin strongly or ever suffered a fractured jaw?○Lifestyle habit・Do you chew on one side(left side or right side)more often when you eat foods?・Do you often rest your cheek on your hand?・Do you like to lie on your stomach or lateral position?・Do you often eat snacks or fast foods?○Response to psychological stress・Have you ever been told that you grind your teeth?・Do you have a habit of clenching your teeth?(Do you always bite strongly?)・Do you feel anxious or worry about anything?・Have you recently had difficulty failing asleep?
Table 2 Standard judgment of temporomandibular disorder based on the results from TMD chart ① of the health chart of TMJ.
A~D : The chart results indicated the abnormality groups, and so each group member needs further testing and occasion-ally requires dental treatment.
⇨Pain the TMJ and the muscles for mastication(masseter muscle, temporal muscle, stemocleidomastoid muscle)
⇨Severe impairment of opening mouth(can not open mouth more than 20 mm): Motility disorder
E~G : The TMJ chart results indicate the high-risk groups, and so each group member requires meticulous observation.⇨Certain symptoms of mild motility disorder or/and sound in TMJ
H : Normal(Maintaining normal condition of TMJ)⇨No apparent abnormalities
24 杉 陽子・清水良昭・深井智子ほか 明海歯学 41, 2012
の発現率との比較」を調査し,学校歯科健診時に顎関節チャートを用いることの有用性を評価した.有用性の評価は,敏感度,特異度,陽性反応適中度,陰性反応適中度,並びに一致率で評価し,開口障害または顎運動異常の判定は,「最大開口量 40 mm 未満」または「下顎偏位あり」11, 26)とした.なお,開口障害を自覚している生徒と自覚していない生徒の最大開口量における差異の統計学的検定には Student の t 検定を用い,有意水準は 5%とした.2)顎関節症状の発現と歯・口の健康状態,生活習慣・習癖,精神的ストレスとの関連性
Table 3 Standard judgment of temporomandibular disorder based on the results from TMD chart ② of the health chart ofTMJ ; about various couses of temporomandibular disorder.
I~L : Dental caries and“summer”teeth(malalignment and/or malocclusion of teeth)adversely affect the bite.⇨Will you like to get the necessary dental treatment.⇨Will you like to get the regular dental examine.⇨Will you like to improve your mastication and chewing before your swallow.
I, J, M, and N : When you masticate and chew something, the one side(left side or right side)of your jaw in under theoverload.
⇨When you bite, will you like to use the both sides of your jaw.⇨Please do not rest your cheek on your hand.⇨Will you like to sleep in lying on your back.
K and O : Your grinding your teeth and strong clamp might be induced by the psychological stress.⇨Please stop your grinding the teeth and clamping strongly.⇨Please do not get stress out.
P : The other courses of temporomandibular disorder⇨It has been suggested the possibility of that the contact sports, playing winds(clarinet and flute), the mixeddentition period relate to the developing of temporomandibular disorder.
顎関節チャートの試作と学校保健での有用性 25
Fig 2 Comparison of the prevalence of subjective symptoms in the TMJ chart.Quantification of the students with the current or previous history of TMD symptom(s)is expressed as a
percentage of the total number of students. Each numerical value in parenthes shows the number of students.
Table 4 Comparison of the prevalence(%)of pain in TMJ and masticatory muscles between the responses to the TMJ chart and the clinicalexamination.
subjective symptom %(number)ST SP PPV NPV TRR
Question items in TMD chartJunior
high schoolHigh
schoolClinical examination
Juniorhigh school
Highschool
Jaw pain7.3%(11)
8.1%(18)
6.0%(9)
8.1%(18) 0.71 0.97 0.69 0.98 95.4%
Do you have pressure−−indused pain on pressure at ①(Masseter muscle)
2.7%(4)
3.6%(8)
Tenderness in massetermuscle
2.7%(4)
4.0%(9)
0.62 0.99 0.67 0.99 97.6%
Do you have pressure−−indused pain at ②(Temporal muscle)
2.0%(3)
1.8%(4)
Tenderness in Temporalmuscle
0.7%(1)
1.8%(4)
0.40 0.99 0.29 0.99 97.8%
Do you have pressure−−induced pain at ③(Stemocleiodmastoid muscle)
2.7%(4)
0.9%(2)
Tenderness in Stemo-cleiodmastoid muscle
3.3%(5)
1.8%(4)
0.44 0.99 0.67 0.99 98.1%
Do you have jaw pain whenopening your mouth?
1.3%(2)
3.6%(8)
TMJ pain when openingmouth
0%(0)
3.1%(7)
0.86 0.99 0.60 0.99 98.7%
Do you have the jaw pain inwhile clenching your teeth?
Table 5 Comparison of the prevalence(%)of dysfunction of the jaw movement and maximal opening of mouth between the TMJ-chart re-sults and the clinical examination results.
Fig 3 Relationship of health-condition of teeth and mouth, lifestyle habit, and psychological stress to the subjective symptoms.The percentage of students in symptom and non-symptom groups giving positive responses to the questions are given. The re-
sults were analyzed by means of the χ 2-test. A probability value of less than 0.05 or 0.01 was considered to be statistically sig-nificant(*p<0.05, **p<0.01).
Fig 4 Kinetics of the subjective symptoms of TMJ revealed by the questions in TMD chart.The plus sign(+)shows“subjective symptom(s)of TMD”; and the minus sign(-),“non symptom”. Quantification
of the students with the current or previous history of TMD is expressed as a percentage of the students without this history.
Fig 5 Kinetics of the subjective symptoms of TMJ noise revealed by the questions in TMD chart.The plus sign(+)indicates“subjective symptom of TMD”; and the minus sign(-),“non symptom”. Quantification
of the students with the current or previous history of TMD is expressed as a percentage of the students without this history.
Fig 6 Persistent abnormality symptoms in TMJ in junior high school and high school students.The plus sign(+)shows“subjective symptom of TMD”; and the minus sign(-),“non symptom”. Quantifica-
tion of the second-year or third-year students with the subjective symptom(s)of TMD is expressed as a percentage ofthe students with the subjective symptom(s)of the disease in the first year in junior high school or high school.
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