やさしさと健康の新世紀を開く 医歯薬出版株式会社

Preface
 顎関節症の病因としてTCH(Tooth Contacting Habit:上下歯列接触癖)の概念を公表してから,10年以上が経過した.TCHが病因であることを発見した当初は,それを是正する有効な手法を見出せず試行錯誤を続けたが,ある時,応用心理学の領域で行われている「習慣逆転法」と呼ばれる行動療法の存在を知った.これをTCHに応用するには3 年ほど工夫を要したものの,現在ではTCH是正訓練の手法は完成したと言えるだろう.
 さらに,顎関節症の病態に対する治療として「リハビリトレーニング」と称した運動療法を,病因治療としてのTCH是正訓練と並行して行うことによって,それまで難治性とされていた顎関節症を効果的に改善できるようになった.そのうえ,患者自身がTCHの有無をチェックして顎関節症の再発を防止することも可能となり,「顎関節症は再発を繰り返す慢性疾患である」という難病感は払拭されてきている.
 TCH是正訓練とリハビリトレーニングについては,すでにそれぞれ書籍を上梓しているが,顎関節症治療においては両者を自転車の両輪のように並行して進めることが重要であるため,本書ではその治療コンセプトを「木野メソッド」としてまとめた.病因と病態に対する診断,治療のポイントをわかりやすく解説するよう努め,実践的な顎関節症治療の入門書として読んでいただけると思う.
 また,本書では新しい試みとして,全編にわたって英語を併記した.TCH是正訓練は非侵襲的かつ効果の高い治療法だが,残念ながら海外ではまだあまり知られていない.しかし最近,世界各地からの見学者や留学生から,「日本にはこんなに優れた治療法があったのか!」と,TCH是正訓練の習得に興味を示してもらえることが多くなった.アジア諸国を含めた多くの国では,歯科関係の書物の多くが英語で書かれており,英語を併記することで海外の歯科医がわれわれの治療コンセプトを理解し,母国で臨床応用してくれることを期待している.
 さらに日本でも,海外からの観光客の増加に伴い,顎関節症で来院する外国人患者を診る機会もあると思われる.そのような時に,英語が併記された本書をチェアサイドで活用していただきたい.付録の問診票の書式も英語版を用意しており,外国人患者の診療をスムーズに進める助けになると思われる.
 本書が多くの歯科医に利用されることで,世界の顎関節症治療が大きく変化し,顎関節症に苦しむ患者さんがいなくなることを願っている.
 2019 年6 月
 木野孔司


 More than ten years have passed since we officially announced the concept of Tooth Contacting Habit(TCH) as an etiology of temporomandibular disorder(TMD). In those days when we found out that TCH might cause TMD,finding effective modalities to correct TCH was thoroughly challenging,however,we had kept practicing trial process.But on one occasion,I learned a behavioral therapy called “habit reversal method” which is utilized in the field of applied psychology.It took approximately three years to modify this method before applying it to TCH,and it can be said that the method of TCH correction training has been completely established.
 In addition,a therapeutic exercise named “rehabilitation training“ is performed to reduce the symptoms of TMD in parallel with TCH correction training as etiological treatment.This combination has effectively improved TMD which had been considered intractable.Moreover,the patients can check the presence of TCH by themselves and prevent the recurrence of TMD.Therefore,the sense of incurability that “TMD is a chronic disease which relapses repeatedly” has been almost eliminated.
 I have already published several textbooks concerning TCH correction training and rehabilitation training respectively.It is critical to proceed both training as two wheels of a bicycle in TMD treatment.The intent of this publication is to organize the treatment concept as“ Kino method” .Diagnosis of etiology and symptoms,as well as treatment tips are clearly explained to make this TMD treatment guide book literally practical.
 As one of our new attempts,English explanation is basically written throghout the text.TCH correction training is a highly effective and non-invasive treatment,unfortunately,it is still unfamiliar overseas.Nevertheless,tremendous interest in mastering TCH correction training has been expressed by many visitors and foreign students from various parts of the world who are impressed by these excellent treatment options originated in Japan.In many regions,including Asian countries,many of the dental literatures are written in English.Appended English in this book will help foreign dentists understand our treatment concept,and clinically practice it in their home countries.
 At the same time,the increase of tourists from overseas could give Japanese dentists opportunities to examine foreign patients with TMD.This book should be utilized as a chairside guide in such situations.Appendices of questionnaire forms are also provided with English versions,which are expected to help take care of foreign patients smoothly.
 I'm hoping that utilization of this book by many dentists would globally innovate TMD treatment modalities to relieve all TMD patients of their symptoms.
 June,2019
 Koji Kino
Chapter 1 木野メソッドの治療コンセプト
 (木野孔司)
 Treatment concept of Kino method Koji Kino
 1.顎関節症の病態と病因の両方にアプローチする
  An approach to both aspects of TMD: symptoms and causes
 2.木野メソッドが高い治療効果を得られる理由
  Reasons for high therapeutic effectiveness of Kino method
Chapter 2 顎関節症患者に対する精神医学的医療面接
 (和気裕之)
 Psychiatric medical interview for TMD patients Hiroyuki Wake
 1.医療面接の基本
  Basic principles of the medical interview
 2.顎関節症患者の特徴をふまえた精神医学的医療面接
  Psychiatric medical interview based on characteristics of TMD
 3.精神科への対診
  Judgment of consultation on psychiatry
Chapter 3 顎関節症の病態診断
 (儀武啓幸)
 Diagnosis of TMD based on pathological conditions Hiroyuki Yoshitake
 1.顎関節症の診断
  Diagnosis of TMD
 2.診察・検査のポイント
  Consultation and examination of TMD
 3.顎関節症の病態分類
  Classification of TMD by The Japanese Society for Temporomandibular Joint
 4.医歯大式病型分類
  Classification of TMD by Tokyo Medical and Dental University
Chapter 4 顎関節症の病態治療
 (儀武啓幸)
 Symptomatic treatment of TMD Hiroyuki Yoshitake
 1.リハビリトレーニングの特徴と効果
  Features and effects of rehabilitation training
 2.リハビリトレーニングの種類と適応症
  Types of rehabilitation training and their indications
Chapter 5 顎関節症の病因診断
 (佐藤文明)
 Etiological diagnosis of TMD Fumiaki Sato
 1.顎関節症の病因の考え方─単一病因説と多因子病因説─
  Interpretations of pathogenesis of TMD-Single etiology and multifactorial etiology-
 2.どの寄与因子を顎関節症治療のターゲットとするか?
  Which contributing factors should be targeted for treatment of TMD?
 3.TCHとは
  Tooth contacting habit
 4.顎関節症の寄与因子としてのTCH
  TCH as a contributing factor of TMD
 5.TCHはどのように定着するのか?
  How does TCH become established?
 6.TCHの診察と診断
  Examination and diagnosis of TCH
Chapter 6 顎関節症の病因治療
 (佐藤文明)
 Etiological treatment of TMD Fumiaki Sato
 1.顎関節症の病因治療の概念
  Concept of etiological treatment of TMD
 2.TCH是正訓練にあたっての注意点
  Important points of TCH correction training
 3.習慣逆転法によるTCHの是正
  Correction training of TCH by habit reversal method
 4.TCH是正の評価
  Evaluation of TCH correction
Chapter 7 治療終了時の患者指導と再発時の対応
 (木野孔司)
 Patient guidance at the end of TMD treatment and management of recurrence Koji Kino
 1.治療終了とする判断基準
  Criteria for terminating TMD treatment
 2.再発防止のため患者に伝えておくべきこと
  Essential information for patients to prevent recurrence
 3.補綴治療・インプラント治療・矯正歯科治療等の開始時期
  Timing for initiation of prosthodontics,implant therapy and orthodontics
 4.顎関節症再発時の対応
  How to manage relapsed TMD
Chapter 8 木野メソッドによる治療例
 (木野孔司)
 Cases treated with Kino method Koji Kino
 Case 1 左咀嚼筋痛障害
  Left myalgia of the masticatory muscle
 Case 2 右顎関節円板障害・右咀嚼筋痛障害
  Right TMJ disc derangement,right myalgia of the masticatory muscle
 Case 3 かくれ顎関節症に咬合違和感を併発
  Hidden-TMD accompanied by occlusal dysesthesia
Appendix 顎関節症初診時質問票,精神医学的面接質問票,生活・行動要因調査票
 Questionnaire for New TMD Patient,Psychiatric Questionnaire,Questionnaire on Living/Behavioral Factors