2 0 0 0 OA 不良姿勢,噛みしめ癖と肩こりの関連性の検討
1 0 0 0 OA 睡眠時ブラキシズムの基礎と最新の捉え方
- 著者
- 鈴木 善貴 大倉 一夫 松香 芳三
- 出版者
- 特定非営利活動法人 日本睡眠歯科学会
- 雑誌
- 睡眠口腔医学 (ISSN:21886695)
- 巻号頁・発行日
- vol.3, no.1, pp.10-21, 2016 (Released:2019-12-20)
- 被引用文献数
- 1
Sleep Bruxism (SB), which has been thought to have various harmful influences to stomatognathic system, is a disease with jaw movement accompanied by excessive occlusal force during sleep. The physiological masticatory muscle activity, which can be observed several times at night even in healthy people, is recently referred to as rhythmic masticatory muscle activity (RMMA) as a biomarker to diagnose SB. Patients who exhibit RMMA over 4 times per hour are diagnosed with SB. It has been suggested that RMMA might be caused by primary factor (brain activation) and/or secondary factor (e.g. sleep apnea, REM behavioral disorder). During RMMA event, phasic or/and tonic masticatory muscle contractions are performed and jaw movement, such as clenching at eccentric jaw position and grinding exceeding canine edge to edge, are specifically observed by recent studies. These jaw movements may cause various signs (e.g. tooth attrition, masticatory muscle pain). However, these signs can be due to other multiple factors( e.g. tooth, daytime oral habits), so it is hard to establish a causal link between SB and the signs. SB has been diagnosed by electromyography, clinical signs and questionnaire. In order to improve the validity of SB diagnostic methods, grading system is recently applied; polysomnography with audio-video recordings, clinical signs, and questionnaire define “definite,” “probable,” and “possible” SB respectively. Since there is still no definitive treatment for SB, dental clinicians have been performing symptomatic therapy such as splint therapy, pharmacotherapy, and behavioral therapy. Splint therapy is the most commonly used therapy on SB patients, but its potential side effects, e.g. worsening sleep breathing disorder, have been reported. Therefore, behavioral therapy, such as sleep hygiene measure and relaxation, needs to be performed first. Unlink the primary SB, the secondary factor might lead to not only negative effect but also positive influences such as activating secretion or diffusion of saliva in gastroesophageal reflux disease patients and releasing stress. Therefore, for the case caused by the secondary factor, dentists should consult with medical specialists from different fields to review and examine the case.
- 著者
- 鈴木 善貴 大倉 一夫 重本 修伺
- 出版者
- Japanese Society of Stomatognathic Function
- 雑誌
- 日本顎口腔機能学会雑誌 (ISSN:13409085)
- 巻号頁・発行日
- vol.17, no.2, pp.113-124, 2010
- 被引用文献数
- 1
睡眠時ブラキシズムの治療には,一般的にオクルーザルスプリントが用いられているが,その作用機序はもちろん,付与すべき咬合挙上量の明確な指標すら未だ不明である.この理由のひとつとして,夜間睡眠中の顎運動を観察,測定することが非常に困難であることが挙げられる.本研究では著者の所属分野で開発した睡眠時6自由度顎運動測定システム(口腔内センサ方式6自由度顎運動測定器-携帯型ポリソムノグラフ-AVモニタ)を用いて,睡眠中の顎運動測定を行い,仰臥位での睡眠中の咀嚼筋安静(低緊張)状態の切歯点における垂直的顎位について解析するとともに,睡眠時ブラキシズムの発現頻度との関係についても検討を行った.被験者は睡眠障害がなく,顎口腔系に異常のない個性正常咬合を有する成人12名(男性7名,女性5名,平均年齢25.5±5.7歳)を対象とし,二夜連続測定を行って,第二夜目のデータを解析対象とした.全被験者とも良好な睡眠状態であり,本測定システムによる睡眠への影響は最小限であった.平均垂直的顎位は2.9~ 6.0 mmであった.垂直的顎位は,睡眠段階の違いによる差はなかったが,Stage 1では2.5~5.0 mmのEpochが有意に多く(<i>P</i><0.05),Stage REM,2,3&4では2.5~5.0 mm,5.0 mm以上のEpochが1.0 mm未満,1.0~2.5 mmのEpochよりも有意に多く認められた(<i>P</i><0.05).垂直的顎位が2.5 mm以上を示すEpochは84.2±16.3%であった.また睡眠時ブラキシズムと平均垂直的顎位の間には負の相関が認められた(R<sup>2</sup>=0.705,<i>P</i><0.05).本研究結果よりヒトは終夜垂直的に開口状態にあり,垂直的顎位は,オクルーザルスプリントに付与すべき咬合挙上量の指標になることが示された.