Dergi Ara >>
Yıl:2007; Cilt: 10; Sayı: 3>> Özet
TAM METİN
Klinik Psikiyatri Dergisi; 2007;10(3):142-150
Temporomandibuler Bozuklukların Psikiyatrik Yönü ve Bruksizm
NE Özen
Kırıkkale Üniv. Tıp Fak. Psikiyatri ABD, Kırıkkale
Temporomandibular bozukluk (TMB), temporomandibular eklem, çiğneme kasları ve ilişkili yapıları ilgilendiren, ağrı ve ağız hareketlerinde kısıtlılıkla seyreden, sık rastlanan bir bozukluktur. Süregen yüz ağrısı yanı sıra, baş ağrısı, kulak çınlaması ve eklem hareketlerinde ağrı yakınması ile başvurular sıktır. Başvurular, diş hekimi, pratisyen hekim, nörolog, fizyoterapi-rehabilitasyon hekimi, anesteziyolog ve psikiyatristlere olabilir. TMB'un oluş nedeni ile ilgili farklı görüşler bulunmaktadır. Süregen ağrının psikolojik boyutu önceden beri bilinmektedir. TMB'un somatizasyon ya da somatoform bozukluklar içinde ele alınması ile ilgili tartışmalar sürmektedir. Genel kabul edilen görüş, multidisipliner bir yaklaşımla ele alınması gereken bir işlev bozukluğu olduğu yönündedir. Bruksizm, diş gıcırdatma ve diş sıkma ile belirli bir motor bozukluk olup stresle arttığı bilinmektedir. Öte yandan bruksizmin varlığında TMB belirtilerinin arttığı gösterilmekle beraber, aralarındaki nedensellik net olarak aydınlanmamıştır. Ancak, TMB'da psikojenik etkenlerin varlığı kabul edilmektedir. Bu derleme yazısında, TMB ve bruksizm ile ilgili genel bilgiler, ağrının psikojenik boyutu, eşlik eden psikiyatrik tanılar ve güncel tedavi yaklaşımları literatür ışığında tartışılmıştır. Çalışmada geriye dönük kaynak taraması yapılmıştır. Bu amaçla yeni çalışmalar yanı sıra, genel bilgiler için klasik bilgilerin yer aldığı görece eski tarihli kaynaklardan da yararlanılmıştır. Pubmed ve Google arama motoru kullanılarak, "temporomandibular eklem, temporomandibular bozukluk, (kronik) ağrı, somatizasyon, bruksizm" ile ilişkili anahtar sözcükler tercih edilmiştir. Sonuç olarak, diş sıkma ve çene kaslarında ağrı ile belirli TMB veya ilişkili yakınmalar ile başvuran hastalarda, öncelikle klinik olarak eşlik eden belirtiler de göz önünde bulundurularak, çok yönlü yaklaşımlarla tedavi olanakları sağlanabilir.

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