RELATIONSHIP BETWEEN EMOTIONAL STRESS AND PSYCHOSOCIAL FACTORS WITH CRANIOMANDIBULAR DYSFUNCTIONS

Autor: Bandić, Božana
Přispěvatelé: Milekić, Bojana, Puškar, Tatjana, Gušić, Ivana, Jeremić, Knežević Milica, Đurović, Koprivica Daniela, Trifković, Branka
Jazyk: srbština
Rok vydání: 2022
Předmět:
Zdroj: CRIS UNS
Popis: Uvod: Kraniomandibularne disfunkcije (KMD) predstavljene su sveobuhvatnim terminom, koji se odnosi na veliki broj simptoma i kliničkih stanja vezanih za mastikatorne mišiće, temporomandibularne zglobove (TMZ) i pripadajuće strukture glave i vrata. Zbog kompleksnosti, ali i mnoštva kontradiktornosti u stavovima o etiologiji, dijagnostici i terapiji ovih poremećaja, tema su istraživanja u stručnoj i naučnoj literaturi. Zahtevi savremenog društva, kao i tempo koji je nametnut u realizaciji istih, predstavljaju stres za pojedinca, koji dovodi do različitih disfunkcionalnosti i poremećaja u organizmu, među kojima su i pojava KMD. Iako u literaturi postoje neosporni dokazi o povezanosti hroničnog bola i psihosocijalnih faktora kod pacijenata sa KMD, i dalje su potcenjeni ovi faktori, nedovoljno ispitani sa više aspekata, sa nejasno definisanim pristupom i značajem procene njihove zastupljenosti. Kompleksnost ovih poremećaja nameće potrebu postavljanja dijagnostike KMD preciznim individualnim pristupom. U proceni etioloških faktora neophodna je kombinacija dijagnostičkih protokola sa dodatnim dijagnostičkim metodama (algometrija, merenje kortizola uzorkovanjem pljuvačke, vizuelno – analogna skala bola - VAS). Samo takav pristup bi omogućio preciznu dijagnostiku, što je preduslov za buduću pravovremenu i adekvatnu terapiju. Cilj: Utvrditi prisustvo i stepen emocionalnog stresa, kao jednog od osnovnih etioloških uzročnika KMD kod ispitanika eksperimentalne i kontrolne grupe. Utvrditi razlike u pojavi psihosocijalnih faktora kod pacijenata sa KMD i ispitanika bez znakova i simptoma KMD. Verifikovanjem stepena intenziteta hroničnog bola utvrditi njegovu povezanost sa znacima i simptomima depresije i somatizacije kod pacijenata sa KMD. Metode: Uzorak je obuhvatao 100 ispitanika, a dijagnoza KMD je utvrđena po principima dijagnostičkih protokola i kriterijuma za istraživanje kraniomandibularnih disfunkcija (engl. Research Daignostic Criteria for Craniomandibular disorders, RDC/CMD), na osnovu kojih su ispitanici podeljeni na eksperimentalnu i kontrolnu grupu. Obe grupe su podjednako stratifikovane po broju, polu i starosnoj dobi ispitanika. Podaci su prikupljani putem anamneze, kliničkog pregleda po principima orofacijalne funkcijske analize, uz primenu standardizovanih upitnika i skala u okviru Axis I i Axis II protokola. Takođe, primenjene su verifikacione dijagnostičke metode merenja hroničnog bola manuelnom palpacijom, algometrijom na mastikatornim mišićima i vizuelno – analognom skalom bola. U cilju monitoringa nivoa kortizola kako bi se identifikovalo prisustvo stresa, vršeno je uzorkovanje pljuvačke dva puta dnevno u salivetama, uzorak se centrifugirao u posebnim aparatima (UNIVERSAL 320 R, Hettich, Germany), zatim se koncentracija kortizola u pljuvačci merila metodom elektrohemiluminiscentni imunoesej (ECLIA), a dobijene vrednosti analizirale na analizatoru Cobas Integra e 411 uz primenu odgovarajućih komercijalnih setova firme Roshe (Germany). Rezultati: U istraživanju je verifikovana dijagnoza mišićnih disfunkcija kod 33 ispitanika (66%), a dijagnoza zglobne disfunkcije postavljena je kod ukupno 17 ispitanika eksperimentalne grupe (34%), sa većom učestalošću kod osoba ženskog pola. Statistički značajno više vrednosti kortizola su dobijene u eksperimentalnoj grupi u odnosu na kontrolnu, tokom oba merenja (p
Introduction: Craniomandibular dysfunctions (CMD) are represented by a comprehensive term, which refers to a large number of symptoms and clinical conditions related to masticatory muscles, temporomandibular joints (TMJ) and associated head and neck structures. Due to the complexity, but also many contradictions in the views on the etiology, diagnosis and therapy of these disorders, they are a topic of research in the professional and scientific literature. The requirements of mmodern society, as well as the pace imposed in their realization, certainly represent stress for the individual, which leads to various dysfunctions and disorders in the body, including the appearance of CMD. There is clear evidence in the literature about the relationship between chronic pain and psychosocial factors in patients with CMD. These factors are still underestimated, insufficiently examined from several aspects, with an unclear approach and need to assess their prevalence. The complexity of these disorders imposes the need to diagnoses CMD with a precise individual approach. In the assessment of etiological factors, combination diagnostic protocols with additional diagnostic methods (algometry, measurement of cortisol by saliva sampling, visual analogue scale - VAS) is nessesary. Only this approach enables precise diagnosis, which is a precondition for future timely and adequate therapy in patientswith CMD. Objectives: To determine the presence and degree of emotional stress, as one of the basic etiological causes оf CMD in the examinees of the experimental and control groups. То determine the differences in the occurrence of psychosocial factors in patients with CMD and subjects without signs and symptoms of CMD. To determine connection between intensity of chronic pain with the signs and symptoms of depression and somatization in patients with CMD. Methods: The sample included 100 subjects, and the diagnosis of CMD was determined according to the research diagnostic criteria for craniomandibular dysorders (RDC/CMD protocol). After that, the subjects were divided into experimental and control groups. Both groups were equally stratified by number, gender and age of respondents. Data were collected using anamnesis, clinical examination according to the principles of orofacial clinical analysis, using standardized questionnaires and scales within the Axis I and Axis II protocols. Also, verification diagnostic methods for measuring chronic pain by manual palpation, algometry on masticatory muscles and VAS were applied. In order to monitor the level of cortisol to identify the presence of stress, saliva was sampled twice a day in salivette, centrifuged in special devices (UNIVERSAL 320 R, Hettich, Germany), then concentration of cortisol in saliva was measured by a method electrochemiluminescent immunoassay (ECLIA) and obtained values were analyzed on a Cobas Integra e 411 analyzer using appropriate commercial sets from Roshe (Germany). Results: The study verified diagnosis of muscle dysfunction in 33 subjects (66%), and the diagnosis of joint dysfunction was found in a total of 17 subjects in the experimental group (34%), with a higher frequency in females. Statistically significantly higher values of cortisol were obtained in the experimental group compared to the control group, during both measurements (p
Databáze: OpenAIRE
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