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Relationship between emotional stress and psychosocial factors with craniomandibular dysfunctions

dc.contributor.advisorMilekić, Bojana
dc.contributor.otherPuškar, Tatjana
dc.contributor.otherGušić, Ivana
dc.contributor.otherJeremić, Knežević, Milica
dc.contributor.otherĐurović, Koprivica, Daniela
dc.contributor.otherTrifković, Branka
dc.creatorБандић, Божана
dc.date.accessioned2022-09-06T08:05:41Z
dc.date.available2022-09-06T08:05:41Z
dc.date.issued2022-06-03
dc.identifier.urihttps://www.cris.uns.ac.rs/DownloadFileServlet/Disertacija163765203817031.pdf?controlNumber=(BISIS)118631&fileName=163765203817031.pdf&id=18941&source=NaRDuS&language=srsr
dc.identifier.urihttps://www.cris.uns.ac.rs/record.jsf?recordId=118631&source=NaRDuS&language=srsr
dc.identifier.urihttps://www.cris.uns.ac.rs/DownloadFileServlet/IzvestajKomisije163765206231420.pdf?controlNumber=(BISIS)118631&fileName=163765206231420.pdf&id=18942&source=NaRDuS&language=srsr
dc.identifier.urihttps://nardus.mpn.gov.rs/handle/123456789/20558
dc.description.abstractUvod: Kraniomandibularne disfunkcije (KMD) predstavljene su sveobuhvatnim terminom, koji se odnosi na veliki broj simptoma i kliničkih stanja vezanih za mastikatorne mišiće, temporomandibularne zglobove (TMZ) i pripadajuće strukture glave i vrata. Zbog kompleksnosti, ali i mnoštva kontradiktornosti u stavovima o etiologiji, dijagnostici i terapiji ovih poremećaja, tema su istraživanja u stručnoj i naučnoj literaturi. Zahtevi savremenog društva, kao i tempo koji je nametnut u realizaciji istih, predstavljaju stres za pojedinca, koji dovodi do različitih disfunkcionalnosti i poremećaja u organizmu, među kojima su i pojava KMD. Iako u literaturi postoje neosporni dokazi o povezanosti hroničnog bola i psihosocijalnih faktora kod pacijenata sa KMD, i dalje su potcenjeni ovi faktori, nedovoljno ispitani sa više aspekata, sa nejasno definisanim pristupom i značajem procene njihove zastupljenosti. Kompleksnost ovih poremećaja nameće potrebu postavljanja dijagnostike KMD preciznim individualnim pristupom. U proceni etioloških faktora neophodna je kombinacija dijagnostičkih protokola sa dodatnim dijagnostičkim metodama (algometrija, merenje kortizola uzorkovanjem pljuvačke, vizuelno – analogna skala bola - VAS). Samo takav pristup bi omogućio preciznu dijagnostiku, što je preduslov za buduću pravovremenu i adekvatnu terapiju. Cilj: Utvrditi prisustvo i stepen emocionalnog stresa, kao jednog od osnovnih etioloških uzročnika KMD kod ispitanika eksperimentalne i kontrolne grupe. Utvrditi razlike u pojavi psihosocijalnih faktora kod pacijenata sa KMD i ispitanika bez znakova i simptoma KMD. Verifikovanjem stepena intenziteta hroničnog bola utvrditi njegovu povezanost sa znacima i simptomima depresije i somatizacije kod pacijenata sa KMD. Metode: Uzorak je obuhvatao 100 ispitanika, a dijagnoza KMD je utvrđena po principima dijagnostičkih protokola i kriterijuma za istraživanje kraniomandibularnih disfunkcija (engl. Research Daignostic Criteria for Craniomandibular disorders, RDC/CMD), na osnovu kojih su ispitanici podeljeni na eksperimentalnu i kontrolnu grupu. Obe grupe su podjednako stratifikovane po broju, polu i starosnoj dobi ispitanika. Podaci su prikupljani putem anamneze, kliničkog pregleda po principima orofacijalne funkcijske analize, uz primenu standardizovanih upitnika i skala u okviru Axis I i Axis II protokola. Takođe, primenjene su verifikacione dijagnostičke metode merenja hroničnog bola manuelnom palpacijom, algometrijom na mastikatornim mišićima i vizuelno – analognom skalom bola. U cilju monitoringa nivoa kortizola kako bi se identifikovalo prisustvo stresa, vršeno je uzorkovanje pljuvačke dva puta dnevno u salivetama, uzorak se centrifugirao u posebnim aparatima (UNIVERSAL 320 R, Hettich, Germany), zatim se koncentracija kortizola u pljuvačci merila metodom elektrohemiluminiscentni imunoesej (ECLIA), a dobijene vrednosti analizirale na analizatoru Cobas Integra e 411 uz primenu odgovarajućih komercijalnih setova firme Roshe (Germany). Rezultati: U istraživanju je verifikovana dijagnoza mišićnih disfunkcija kod 33 ispitanika (66%), a dijagnoza zglobne disfunkcije postavljena je kod ukupno 17 ispitanika eksperimentalne grupe (34%), sa većom učestalošću kod osoba ženskog pola. Statistički značajno više vrednosti kortizola su dobijene u eksperimentalnoj grupi u odnosu na kontrolnu, tokom oba merenja (p<0,0005), i bile su učestalije kod ispitanika ženskog pola. Dokazana je pozitivna korelacija između psihološke i endokrine varijable, odnosno da je kod osoba sa znacima i simptomima KMD prisutan emocionalni stres u značajnoj meri, a time i više vrednosti salivarnog kortizola u odnosu na ispitanike kontrolne grupe. Utvrđena je pozitivna korelacija između vrednosti kortizola i parametara skala depresije (p=0,590) i somatizacije (p=0,385) kod ispitanika eksperimentalne grupe, odnosno više vrednosti kortizola su praćene višim stepenom depresije i somatizacije. T- testom nezavisnih uzoraka je utvrđeno statistički značajno veće prisustvo simptoma depresije, somatizacije i nespecifičnih simptoma u eksperimentalnoj grupi u odnosu na kontrolnu grupu (depresija p=0,001, somatizacija p<0,0005, nespecifični faktori p=0,003). Znaci i simptomi depresije i somatizacije kod ispitanika sa KMD su u pozitivnoj, statistički značajnoj korelaciji sa višim intenzitetom hroničnog bola verifikovanog numeričkom manuelnom palpacijom. Pri poređenju ispitanika eksperimentalne i kontrolne grupe, vrednosti algometrijskih merenja na m. temporalisu (leva, desna strana i ukupna vrednost) i na m. masseteru (leva, desna strana i ukupna vrednost) su pokazale da je prag bola niži prilikom svih merenja kod ispitanika eksperimentalne u odnosu na ispitanike kontrolne grupe (p<0,0005). Zaključak: Stres i psihosocijalni faktori su prisutni, u različitom stepenu izraženi i identifikovani kao značajni faktori u etiologiji KMD, posebno kod dijagnoze mišićnih disfunkcija. Intenzivna prevalencija stresa i mnoštvo biopsihosocijalnih faktora jasno utiču na nastanak KMD nizom mehanizama, delujući kroz okluzalne faktore i putem promena u aktivnosti mastikatornih mišića, a takođe i pojavom depresivnih simptoma i bola kao vodećeg simptoma KMD. Opservacijom svih skala Axis II RDC/CMD protokola potvrđena je njihova vrednost kao stratifikovanog i preciznog dijagnostičkog instrumenta u opservaciji psihosomatskih faktora, kao neodvojivih elemenata KMD poremećaja.sr
dc.description.abstractIntroduction: Craniomandibular dysfunctions (CMD) are represented by a comprehensive term, which refers to a large number of symptoms and clinical conditions related to masticatory muscles, temporomandibular joints (TMJ) and associated head and neck structures. Due to the complexity, but also many contradictions in the views on the etiology, diagnosis and therapy of these disorders, they are a topic of research in the professional and scientific literature. The requirements of mmodern society, as well as the pace imposed in their realization, certainly represent stress for the individual, which leads to various dysfunctions and disorders in the body, including the appearance of CMD. There is clear evidence in the literature about the relationship between chronic pain and psychosocial factors in patients with CMD. These factors are still underestimated, insufficiently examined from several aspects, with an unclear approach and need to assess their prevalence. The complexity of these disorders imposes the need to diagnoses CMD with a precise individual approach. In the assessment of etiological factors, combination diagnostic protocols with additional diagnostic methods (algometry, measurement of cortisol by saliva sampling, visual analogue scale - VAS) is nessesary. Only this approach enables precise diagnosis, which is a precondition for future timely and adequate therapy in patientswith CMD. Objectives: To determine the presence and degree of emotional stress, as one of the basic etiological causes оf CMD in the examinees of the experimental and control groups. То determine the differences in the occurrence of psychosocial factors in patients with CMD and subjects without signs and symptoms of CMD. To determine connection between intensity of chronic pain with the signs and symptoms of depression and somatization in patients with CMD. Methods: The sample included 100 subjects, and the diagnosis of CMD was determined according to the research diagnostic criteria for craniomandibular dysorders (RDC/CMD protocol). After that, the subjects were divided into experimental and control groups. Both groups were equally stratified by number, gender and age of respondents. Data were collected using anamnesis, clinical examination according to the principles of orofacial clinical analysis, using standardized questionnaires and scales within the Axis I and Axis II protocols. Also, verification diagnostic methods for measuring chronic pain by manual palpation, algometry on masticatory muscles and VAS were applied. In order to monitor the level of cortisol to identify the presence of stress, saliva was sampled twice a day in salivette, centrifuged in special devices (UNIVERSAL 320 R, Hettich, Germany), then concentration of cortisol in saliva was measured by a method electrochemiluminescent immunoassay (ECLIA) and obtained values were analyzed on a Cobas Integra e 411 analyzer using appropriate commercial sets from Roshe (Germany). Results: The study verified diagnosis of muscle dysfunction in 33 subjects (66%), and the diagnosis of joint dysfunction was found in a total of 17 subjects in the experimental group (34%), with a higher frequency in females. Statistically significantly higher values of cortisol were obtained in the experimental group compared to the control group, during both measurements (p<0.0005), and werе morе common in female subjects. A positive correlation was found between the psychological and endocrine variables, and in people with signs and symptoms of CMD there was emotional stress at a significant level and higher values of salivary cortisol compared to the subjects in control group. A positive correlation between cortisol values and parameters of the depression scale (p=0.590) and somatization scale (p=0.385) was found in the experimental group, which means that higher cortisol values were followed by a higher degree of depression and somatization. T-test showed a statistically significantly higher presence of symptoms of depression, somatization and nonspecific factors in the experimental group compared to the control group (depression p=0.001, somatization p<0.0005, nonspecific factors p=0.003). Signs and symptoms of depression and somatization in subjects with CMD are positively, statistically significantly correlated with higher intensity of chronic pain verified by numerical manual palpation. When we compare the examinees of the experimental and control groups, the values of all algometric measurements on the m. temporalis (right, left side and total value) and on the m. masseter (right, left side and total value) showed that the pain threshold is lower at each measuring in experimental compared to control group (p<0.0005). Conclusion: Stress and psychosocial factors are present, expressed to varying degrees and identified as significant factors in the etiology of CMD, especially in the diagnosis of muscular dysfunctions. The intense prevalence of stress and many biopsychosocial factors clearly influence the development of СMD through a number of mechanisms, acting through occlusal factors and through changes in the activity of masticatory muscles, as well as the appearance of depressive symptoms and pain as the leading symptom of СMD. Observation of all scales of the Axis II RDC/CMD protocol confirmed their value as a stratified and accurate diagnostic instrument in the observation of psychosomatic factors, as significant elements of these disorders.en
dc.languagesr (latin script)
dc.publisherУниверзитет у Новом Саду, Медицински факултетsr
dc.rightsopenAccessen
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.sourceУниверзитет у Новом Садуsr
dc.subjectKraniomandibularni poremećaji, dijagnoza, pljuvačka, merenje bola, psihološki stres, depresijasr
dc.subjectCraniomandibular Disorders, Diagnosis, Saliva, Pain Measurement; Stress, Psychological, Depressionen
dc.titlePovezanost emocionalnog stresa I psihosocijalnih faktora sakraniomandibularnim disfunkcijamasr
dc.title.alternativeRelationship between emotional stress and psychosocial factors with craniomandibular dysfunctionsen
dc.typedoctoralThesissr
dc.rights.licenseBY-NC-ND
dc.identifier.fulltext$DSPACE_URL/bitstream/id/145264/Izvestaj_komisije_12517.pdf
dc.identifier.fulltext$DSPACE_URL/bitstream/id/145263/Disertacija_12517.pdf
dc.identifier.rcubhttps://hdl.handle.net/21.15107/rcub_nardus_20558


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