slovenski

Vplivi temporomandibularnih motenj in bruksizma ter zdravljenja z relaksacijsko opornico na kakovost življenja pri slovenskih bolnikih

Namen dela. Prevod vprašalnika »Oral Health Impact Profile« v slovenščino in testiranje psihometričnih lastnosti vprašalnikov OHIP-SVN in OHIP-SVN14. Ugotavljanje vplivov temporomandibularnih motenj, opredeljenimi s protokolom »Raziskovalni diagnostični kriteriji za temporomandibularne motnje«, in bruksizma na kakovost življenja pri slovenskih bolnikih. Vrednotenje počutja pacientov z bruksizmom v prvem letu terapije z relaksacijsko opornico in ugotavljanje vpliva terapije na kakovost življenja z vprašalnikom OHIP-SVN. Preiskovanci in metode. Sočasna veljavnost vprašalnikov OHIP-SVN in OHIP-SVN14 je bila testirana na 430 Slovencih, test-retestna zanesljivost na 60 Slovencih, notranja konsistentnost na 460 Slovencih in odzivnost na 30 Slovencih s potrebo po zdravljenju zaradi zobobola. Kakovost življenja je bila vrednotena pri 81 bolnikih s temporomandibularno motnjo in 94 pacientih z bruksizmom, sprejetih na Centru za fiksno protetiko in gnatologijo (SPS Stomatološka klinika, Univerzitetni klinični center v Ljubljani) v letih 2006-2008. Vpliv nošenja relaksacijske opornice na kakovost življenja smo spremljali pri 47 pacientih v prvem letu terapije. Rezultati. Vprašalnika OHIP-SVN in OHIP-SVN14 imata zadovoljive psihometrične lastnosti. Bolniki s temporomandibularnimi motnjami in pacienti z bruksizmom imajo statistično značilno slabšo kakovost življenja v primerjavi s splošno populacijo (za obe skupini je p<0, 001). Višja starost (p<0, 001), več opredeljenih diagnoz v okviru temporomandibularnih motenj (p<0, 001), prisotnost omejenih premikov čeljusti (p<0, 05) in artropatije (p=0, 014) prispevajo k slabši kakovosti življenja. Bolniki s temporomandibularnimi motnjami imajo statistično značilne višje vrednosti pri vseh sedmih področjih OHIP-SVN v primerjavi s splošno populacijo (pri vseh področjih je p<0, 001). Pri bruksizmu imajo največji vpliv na kakovost življenja omejena funkcionalnost, bolečine v stomatognatem sistemu, starost ter psihična prizadetost. Ženske z bruksizmom navajajo več jutranjih glavobolov, težko premikanje čeljusti po bujenju, občutljivost žvečnih mišic in čeljustnih sklepov ter večje težave pri obvladovanju napetosti, stresov in pritiskov, ki jih doživljajo v življenju, ter manj tveganega stresnega vedenja v primerjavi z moškimi z bruksizmom. Vsak sedmi pacient z bruksizmom je prekinil s terapijo z relaksacijsko opornico v manj kot pol leta. Pri eni tretjini pacientov z bruksizmom je nošenje relaksacijske opornice poslabšalo kakovost spanja. V nekaj dnevih zdravljenja bruksizma z relaksacijsko opornico ni več statistično značilne razlike v kakovosti življenja pri pacientih z bruksizmom v primerjavi s splošno populacijo (p=0, 109). Po večmesečnem nošenju opornice ni bilo več statistično značilne razlike glede bolečin na področju SGS v primerjavi s splošno populacijo (p=0, 170), statistično značilno pa so se v tem času povečale psihološke težave (p=0, 007). Zaključek. Vprašalnik OHIP-SVN je učinkovit instrument za ugotavljanje vplivov temporomandibularnih motenj, bruksizma in terapije z opornico na kakovost življenja. ABSTRACT Aims. To translate the »Oral Health Impact Profile« questionnaire into Slovenian language and to test the psychometric properties of both, long version OHIP-SVN49 and short version OHIP-SVN14 questionnaires. To determine the impact of temporomandibular disorders (TMD) defined by the protocol »Research diagnostic criteria for TMD, « and bruxism, on the oral health related quality of life (OHRQoL) of Slovenian patients. The purpose was also to monitor the effect of relaxation splint therapy during the first year of wearing and to assess the impact of such therapy on the OHRQoL using the OHIP-SVN49 questionnaire. Subjects and methods. Concurrent validity of questionnaires OHIP-SVN49 and OHIP- SVN14 was tested on 430 individuals, test- retest reliability was tested on 60, internal consistency on 460, and responsiveness on 30 individuals with treatment needs due to toothache. The OHRQoL was evaluated in 81 TMD patients and in 94 bruxists from the Center for the Fixed Prosthodontics and Occlusion (SPS Dental Clinic, University Clinical Center in Ljubljana) during the years 2006-2008. The effects of the relaxation splint therapy on the OHRQoL were assessed in the 47 bruxists through one-year of treatment (or splint wearing). Results. The results revealed that both, OHIP- SVN49 and OHIP-SVN14 questionnaires showed satisfactory psychometric properties. Both, the TMD patients and the bruxers had significantly lower OHRQoL compared with the general population (p<0.001). Higher age (p<0.001), more diagnoses identified in the context of TMDs (p<0.001), limited jaw movement (p<0.05) and arthropaties (p=0.014) contributed to a worse quality of life in TMD patients. The TMD patients had significantly higher values in all seven domains of OHIP-SVN49 compared with the general population (p<0.001). Functional limitation, orofacial pain, age and psychological disability, had the greatest impact on the OHRQoL in patients with bruxism. Women suffering from bruxism indicated more morning headaches, more difficulties in jaw movements when they wake up, more sensitivity of masseter muscles and the TM joints, as well as greater difficulty in managing tension, stress and pressures experienced in life and less stress risk behaviors compared with men with bruxism. Every seventh patient with bruxism abandoned the relaxation splint therapy in less than half a year. One third of patients with bruxism reported the deterioration of the quality of sleep during the relaxation splints therapy. Within a few days of relaxation splint treatment there were no longer significant differences considering OHRQoL between bruxsers and general population (p=0.109). After several months of splint therapy there was no longer significant difference in orofacial pain, compared with the general population (p=0.170). However, significant increase in psychological discomfort was registered in bruxers (p=0.007). Conclusion. The OHIP-SVN questionnaire is an effective instrument for determining the effects of TMD, as well as bruxism and relaxation splint therapy on the quality of life.

Kakovost življenja ; temporomandibularne motnje ; bruksizem ; okluzijska opornica ; vprašalnik ; OHIP ; RDC/TMD protokol

Rad je nastao temeljem bilateralnog projekta sa Slovenijom, a prof. dr.sc. Asja Čelebić (Stomatološki fakultet Zagreb) bila je mentor disertacije na Sveučilištu u Ljubljani.