咬肌疼痛對於軟食咀嚼效率之影響

Abstract

本研究的目的為使用標準化軟質測試食物，評估咬肌疼痛對於軟食咀嚼效率的影響，並評估經皮膚電刺激療法(TENS)對咀嚼肌肌筋膜疼痛的療效。 受試者為22位患有咬肌（masseter muscle）疼痛的女性，所有受試者皆具有完整齒列、無牙齒缺失或牙周疾病，無牙橋贗復物與顳顎關節疼痛，且其咬合分類上皆屬安格式第一類咬合(Angle’s Class I)。實驗對照組資料主要參考本實驗室簡麟懿醫師的研究數據（簡麟懿,2006）。實驗用的標準化測試物為包含hydroxylapatite (HA)顆粒之無糖口香糖塊，受試者坐在沒有頭靠的椅子上以其患側依每一秒鐘嚼一下之節奏咀嚼測試物，連續測試三次，每次咀嚼25下。依咀嚼後口香糖中HA顆粒分布的均勻度作為混合效率（mixing efficiency）的參考依據。咀嚼時之下顎運動也利用BioPAK顎運動追蹤器(EGN)觀察。所有測試者都接受三天一次、一次十五分鐘、總共五次的經皮膚電刺激療法（TENS）療程。療程結束之後再進行一次咀嚼測試，用來比較經皮膚電刺激療法治療（TENS）對軟食咀嚼效率的影響。每次TENS治療前後皆利用壓力痛覺計(pressure algometer)來記錄病人的壓力疼痛閥值（pressure pain threshold）及記錄病人的視覺分析值 (Visual Analog Scale) 以表現病人主觀的疼痛指數。 由統計結果發現：咬肌疼痛的病人之咀嚼效率比沒有咀嚼肌疼痛的正常人差，而且此差異具有顯著差異（P<0.05）。在五次的經皮膚電刺激療法（TENS）中，壓力疼痛閥值（PPT）有逐次增高的趨勢；而從視覺分析表得到的VAS值也相對的有逐次減少的趨勢；TENS治療前後疼痛閥值（PPT）變化和VAS值的變化為負相關。咀嚼效率在經皮膚電刺激療法（TENS）之後有顯著的改善，但仍不若正常人。在咀嚼週期型態的分析上，最大上下位移量（UL range）、垂直方向開口瞬間最大速度(UL-O-V) 、前後位移量(AP range)、前後方向開口瞬間最大速度(AP-O-V)、前後方向閉口瞬間最大速度(AP-C-V)、側面觀咀嚼週期水平位移 (S-C-D)方面，咬肌疼痛病人所測量出的數值皆明顯小於沒有咀嚼肌疼痛的正常人所測量到的數值。唯有正面觀咀嚼週期之水平位移 (F-C-D)方面，咬肌疼痛的病人顯著的大於沒有咀嚼肌疼痛的正常人，但咬肌疼痛病人在F-C-D的變異係數（CV）也比正常人來的大並且有顯著差異，表示咬肌疼痛病人的咀嚼型態較不穩定。其他變項則沒有顯著相關。 實驗結果顯示：咬肌疼痛的病人咀嚼效率比正常人低，在經過經皮膚電刺激療法（TENS）之後會有顯著的改善，但仍無法回復正常的咀嚼效率。

The purpose of this study was to evaluate the effect of masticatory myofascial pain on soft food mixing efficiency by using a standardized test food. And to evaluate the curative effect of transcutaneous electronic nerve stimulation (TENS) on patients with masticatory myofascial pain. 22 female patients were included in this study. All subjects suffered from masticatory myofascial pain which had Angle’s Class I complete dentition, no dental missing or periodontal disease, no denture restoration other than single crowns and no tempromandibular joint pain. The test food was a chewing gum block containing hydroxylapatite (HA) particles. All subjects sat in the chair without head rest, and chewed with their affected side under a constant rhythm (60Hz) three times and each chewing test contains 25 strokes. After chewing, the HA homogeneity within the gum bolus was calculated and defined as mixing efficiency. The chewing movement was recorded with sironathograph (BioPAK JT3 system). All the subjects received the treatment of transcutaneous electronic nerve stimulation (TENS) treatment. The total treatment course of TENS was 5 times with the protocol of 15 minutes a time and interval of three days. After finishing the treatment courses, the chewing test was performed to compared the curative effect of TENS. We checked the pressure pain threshold with algometer and the severity of pain with Visual Analog Scale before and after every treatment. The data show that that, the chewing efficiency of patients was less than the normal subjects(P<0.05).During five times treatment of transcutaneous electronic nerve stimulation, the pressure pain thresholds increased、 the value of VAS decreased gradually. We found that there was a negative correlation between PPT and VAS. The chewing efficiency of patients got better after receiving the treatment of transcutaneous electronic nerve stimulation, but still not so well as compared with the normal subjects. About the analysis of chewing cycle, we found that the vertical displacement (UL range) of the patients which were suffering from masseter muscle pain was significantly smaller than the normal group. Besides, other parameters such as AP range, UL-O-V, AP-O-V, AP-C-V, S-C-D of patients are smaller than that of the normal subjects. Although the data showed that the patient’s frontal chewing displacement (F-C-D) were significantly larger than the normal subjects, the standard deviation of patient’s F-C-D was greater than that of the normal subject significantly. Other parameter of jaw motion are no significant different between patients and the normal subjects in the study.