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Rad Croatian Academy of Sciences and Arts. Medical science : Medical Sciences, No.507=34 April 2010. -

Temporomandibular disorders TMD is an umbrella term covering a series of pathologic conditions which can have similar signs and symptoms and which lead to an imbalance in the normal functioning of stomatognatic system. Temporomandibular disorders are defined as a group of orofacial disorders with pain in the preauricular area, jaw joints TMJ or masticating muscles with limitations in range and deviations of lower jaw’s movement as well as TMJ sounds during mastication. When the pathophysiologic factor is known, the pain is conventionally classified as -specific- and when it is unknown it is called -nonspecific-, psychogenic, idiopathic, conversive or euphemistic atypical pain. Nonspecific pain of the TMD is very often a symptom of a psychiatric disorder, for example depression with somatic symptoms, hypochondria, psychosis or is classified in the group of somatoform psychiatric disorders according to contemporary classification systems, e.g. the American Psychiatric Association’s DSM-IV 7 and the International Classification of Diseases ICD-10.

TMD affects 12% of overall population. Psychological-psychiatric problems prevail among patients with TMD, anxious-depressive disorder is found in 50%, while depression in 32.1% of patients. Patients with psychiatric problems are 4.5 times more prone to TMD than individuals without psychiatric problems and vice versa.

TMD is connected with numerous etiologic factors, which renders early and precise diagnosis as well as efficient therapy more difficult. Five main factors are usually listed as connected to TMD: trauma, occlusion, habits parafunctional activities, such as chewing a piece of gum, chewing on one side, teeth clenching, bruxism, deep pain stimulus, psychological problems connected with emotional stress, and psychiatric disorders. Psychological and psychiatric factors of TMD are the focus of this paper.

Treating nonspecific, psychogenic pain disorders is not possible without a holistic, integrative, interdisciplinary team approach of psychiatrists, psychologists, physiologists, neurologists and sometimes even neurosurgeons. Cognitive-behavioral psychotherapy is prevalent as well as techniques of alleviating anxiety and stress autogenic training, physiologic therapy, EMG biofeedback methods and psychopharmacotherapy.

temporomandibular disorders; pain disorder; nonspecific pain; specific pain; psychotherapy; psychopharmacotherapy



Autor: Danijel Buljan - ; Sestre milosrdnice University Hospital, Zagreb, Croatia

Fuente: http://hrcak.srce.hr/



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