大学生颞下颌关节紊乱病与口腔行为、心理状态的关系研究

Study on the Relationship between Temporomandibular Joint Disorders and Oral Behaviors, Psychological Status among College Students

摘要: 目的：探究高校大学生颞下颌关节紊乱病(TMD)患病现状，构建人口学、颌面部病史、口腔行为、心理情绪多维度分析框架，筛选TMD独立影响因素，为青年群体TMD早期筛查与校园口腔干预提供实证依据。方法：采用横断面调查，纳入某高校676名本科及研究生，构建人口学、口颌病史、口腔行为习惯、心理情绪四大维度调研体系；先采用χ²检验、Mann-Whitney U检验开展单因素分析，经多重共线性诊断排除变量共线性干扰后，采用二元Logistic回归筛选TMD独立影响因素并分析关联强度。结果：该大学生群体TMD患病率为24.4%；二元Logistic回归显示，存在口腔治疗经历(OR = 1.867, 95% CI = 1.216~2.865, p = 0.004)、颌面部外伤史(OR = 1.774, 95% CI = 1.089~2.890, p = 0.021)、夜间频繁磨牙(OR = 1.444, 95% CI = 1.235~1.688, p < 0.001)、经常进食硬质食物(OR = 1.227, 95% CI = 1.010~1.491, p = 0.040)是TMD独立危险因素；日常保持大笑习惯(OR = 0.719, 95% CI = 0.582~0.889, p = 0.002)、日常唱歌(OR = 0.763, 95% CI = 0.634~0.919, p = 0.004)为TMD独立保护因素；单因素有统计学差异的性别、偏侧咀嚼、焦虑压力在多因素模型中无独立作用(p > 0.05)。结论：二元Logistic回归模型可有效区分大学生TMD患病风险，既往颌面损伤、夜间磨牙、长期咀嚼硬物、口腔治疗史会显著升高发病概率，日常大笑、唱歌这类节律性下颌活动可降低患病风险，我们提出科学假说：适度频率的非专业性歌唱与大笑可能通过促进颞下颌关节滑液循环、增强肌肉协调性，从而降低TMD发生风险。未来研究可针对此假说进行机制验证与干预试验，可为高校TMD分层健康宣教与精准干预提供理论支撑。

Abstract: Objective: To explore the prevalence of temporomandibular joint disorders (TMD) among college students, establish a multi-dimensional analysis framework including demography, maxillofacial history, oral behaviors and psychological emotions, screen independent influencing factors of TMD, and provide empirical evidence for early TMD screening and campus oral intervention in young adults. Methods: A cross-sectional survey was carried out, enrolling 676 undergraduates and postgraduates from a university, and a four-dimensional research system covering demography, oromaxillofacial medical history, oral behaviors and psychological emotions was constructed. Univariate Chi-square test and Mann-Whitney U test were performed first. After multicollinearity diagnosis to eliminate collinearity interference among variables, binary Logistic regression was adopted to screen independent influencing factors of TMD and analyze correlation strength. Results: The prevalence of TMD in this population was 24.4%. Binary Logistic regression showed that history of oral treatment (OR = 1.867, 95% CI = 1.216~2.865, p = 0.004), maxillofacial trauma (OR = 1.774, 95% CI = 1.089~2.890, p = 0.021), frequent night bruxism (OR = 1.444, 95% CI = 1.235~1.688, p < 0.001) and frequent intake of hard food (OR = 1.227, 95% CI = 1.010~1.491, p = 0.040) were independent risk factors for TMD; regular laughing (OR = 0.719, 95% CI = 0.582~0.889, p = 0.002) and regular singing (OR = 0.763, 95% CI = 0.634~0.919, p = 0.004) were independent protective factors of TMD. Gender, unilateral mastication and anxiety stress which had statistical differences in univariate analysis showed no independent effect in multivariate model (p > 0.05). Conclusion: The binary Logistic regression model can effectively distinguish TMD risk among college students. Previous maxillofacial injury, night bruxism, long-term hard food chewing and oral treatment history significantly increase the incidence risk, while rhythmic mandibular movements such as daily laughing and singing can reduce morbidity. We put forward a scientific hypothesis that moderate‑frequency non‑professional singing and laughing may reduce the risk of TMD by promoting synovial fluid circulation of temporomandibular joint and enhancing muscle coordination. Future studies can conduct mechanistic verification and intervention trials for this hypothesis, which can provide theoretical support for hierarchical health education and targeted TMD intervention in universities.