• Journal of Oral Medicine and Pain
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• v.31 no.4
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• pp.327-335
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• 2006

Generally, Tension-Type Headache(TTH) patients exhibit muscle pain, but can also have TMJ pain, which includes mouth opening limitation or joint sounds. The purpose of our study is to observe the clinical pain characteristics between TTH patients with muscle pain and TMJ pain. One hundred sixty-seven patients were diagnosed with TTH according to the questionnaires based on the International Headache Society's proposal on the diagnostic criteria of TTH. The patients were classified into three group; arthralgia group (18 patients), myalgia group (50 patients) and arthromyalgia group (99 patients). TTH patients with pericranial muscle pain were classified in the myalgia group. TTH patients with temporal region pain were classified in the arthralgia group. TTH patients with both types of pain were classified in the arthromyalgia group. The parameters in the diagnostic criteria such as quality, intensity, laterality of pain, and aggravation due to physical activities were compared among the three groups. 1. There were no significant differences in the quality of pain among the three groups. 2. There were no significant differences in the intensity of pain among the three groups. 3. There were no significant differences in the laterality of pain among the three groups. 4. A higher percentage of patients in the arthromyalgia group experienced headaches that were aggravated due to physical activity (p=0.03) compared to the other groups. The results of this study show that TTH patients with both arthralgia (TMJ pain) and myalgia (pericranial muscle pain) are more aggravated by physical activity than TTH patients with either one.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.1
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• pp.38-46
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• 2016

Purpose: study for discriminating method of origin side vibration from non-symptomatic clicking group. Materials and Methods: 60 joints vibrations of 30 subjects in non-symptomatic clicking group was recorded via subject's awareness, examiner's palpation and JVA analysis. Origin side vibration was discriminated with consideration for frequency spectrum, time delay and phase shift of waveforms, analysis of numeric values. Results: There were all unilateral vibrations with JVA analysis and number of origin vibrations were 42. 11 pairs of vibrations showed time delay and phase shift and transferred side vibrations showed smaller values of total integral and bigger values of > 300 / < 300 ratio than origin side vibrations except one pair of vibrations. Also as the ipsi-lateral joint vibrations with smaller values of total integral showed bigger values of > 300 / < 300 ratio than the contra-lateral joint vibrations and there all ipsi-lateral vibrations were showed small values of total integral below 10 and hard to detect time delay and phase shift. So the features were used in discrimination of origin side vibrations. Conclusion: There should be all-around considerations for discrimination of origin side vibrations that is frequency spectrum, phase shift and time delay and analysis of numeric values.

• Journal of Oral Medicine and Pain
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• v.35 no.1
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• pp.83-91
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• 2010

Objectives: This study aimed to assess the characteristics of temporomandibular disorder (TMD) symptoms and to determine the correspondence between TMD symptoms and clinical examination findings. Material and methods: A total of 218 patients (143 females and 75 males; age=$31.3{\pm}14.0$) were enrolled in this study who completed a questionnaire and underwent a clinical examination and radiographic assessment. Patients were asked about all the symptoms and complaints, including onset or duration, and locations of the symptoms. Clinical examination included amounts of mouth opening, palpable temporomandibular joint (TMJ) sounds, and tenderness to palpation of the TMJ and all masticatory muscles. Tenderness scores obtained from palpation of the masticatory system were summated to define the variables for further analysis. Results: Pain was the most frequently reported symptom (78.9%), followed by joint sounds (45.4%), and limitation in mouth opening (17.0%). Jaw pain comprised 91.9% of pain complaints. The subjective intensity of jaw pain was low to medium in most patients (93.7%), but it was poorly correlated with the sum of tenderness scores of the TMJ and masticatory muscles (Kendall tau = 0.084). In contrast, the side in which pain was reported by patients was well associated with the clinical examination results (pain of the right side, p < 0.001, and left side, p < 0.001). There was moderate agreement in TMJ sounds between the side identified by patients as symptomatic and clinical examination findings (kappa = 0.482). Finally, patients who complained of restricted mouth opening showed about a 10 mm less opening in all three measurements, compared to other patients (p < 0.001). Conclusion: The most frequent symptoms reported by TMD patients were jaw pain, TMJ sounds, and mouth opening limitation. The side of jaw pain, the side of TMJ sounds, and the presence of opening limitation were highly concordant between symptom reports and examination findings.

• Journal of Oral Medicine and Pain
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• v.33 no.4
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• pp.339-352
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• 2008

Aims: The aims of this study were to identify the association between cervical muscle pain and TMD by pressure pain response, and to find cervical muscles showing moderate to severe pressure pain that are correlated with masticatory muscle pain. Methods: Patients(n=129, female 65.9%, mean age 28.8 years) answered a TMD questionnaire asking about headache, neck pain, emotional stress, sleep disturbance, parafunction habits, and pain intensity. A clinical examination of the masticatory system was performed. Of the neck muscles, (1) the upper sternocleidomastoid, (2) the middle sternocleidomastoid, (3) the upper trapezius, (4) the splenius capitis, (5) the semispinalis capitis, (6) the scalene medius, and (7) the levator scapulae muscles were examined by palpation. Pressure pain or tenderness of all palpation sites was scored from 0 to 3 according to the pain response. The variables of sum of pressure pain scores were calculated from pressure pain scores and were used for statistical analyses. Results: Eighty patients(62.0%) answered that they suffer from neck pain in the TMD questionnaire. More than 40% of sternocleidomastoid and upper trapezius examination sites showed moderate to severe tenderness in the cervical muscles, and 36% of middle masseter in the masticatory muscles. For the 129 patients, the sum of cervical muscle pain scores(mean=12.88, SD=8.06) and the sum of TMD pain scores(mean=5.36, SD=5.10) were moderately correlated($\rho$ = 0.502, P < 0.001). The sum of TMD pain scores tends to increase as the sum of cervical muscle pain scores increases(Y = 0.395${\cdot}$X, $R^2$ = 0.659, P < 0.001). In the patients with masticatory muscle disorders, the sum of sternocleidomastoid and upper trapezius pain scores(mean = 8.67, SD = 4.95) and the sum of temporalis and masseter pain scores(mean = 3.37, SD = 3.56) showed moderate correlation($\rho$ = 0.375, P < 0.001). Those two variables were in a proportionate relationship(Y = 0.359${\cdot}$X, $R^2$ = 0.538, P < 0.001). In a partial correlation analysis of the sum of unilateral pain scores, the sum of right cervical muscle pain scores and the sum of left cervical muscle pain scores showed the highest correlation(r = 0.802, P < 0.001). The sum of right TMD pain scores and the sum of left TMD pain scores were moderately correlated(r = 0.481, P < 0.001). For the twenty patients with unilateral TMD pain, the partial correlation coefficient between the sum of ipsilateral cervical muscle pain scores and the sum of contralateral cervical muscle pain scores was the largest(r = 0.597, P = 0.009). A partial correlation between the sum of primary TMD side pain scores and the sum of ipsilateral cervical muscle pain scores was 0.564(P = 0.015). Conclusions: TMD is associated with cervical muscle pain on condition of pressure pain response to palpation. Of the cervical muscles, sternocleidomastoid and upper trapezius frequently exhibit moderate to severe pressure pain, and they are closely related to the masticatory muscle pain. The characteristic of symmetric involvement of pain is prominent in cervical muscles; however, TMD can affect the level of cervical muscle pain to modify its symmetric nature.

• Journal of Oral Medicine and Pain
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• v.35 no.3
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• pp.213-219
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• 2010

Aim: The aims of this study were to survey the frequency of pain to palpation of the occipitofrontalis muscle in a TMD patient group, and to identify patients showing pain to palpation of the occipitofrontalis muscle that is also consistent with patients' headache symptom. Methods: A total of 218 TMD patients ($32.0{\pm}13.1$ years) participated in this study. Patients' symptoms, including headache, were surveyed by questionnaire. Temporomandibular joints, jaw muscles, and pericranial muscles including the occipitofrontalis muscle were examined with digital palpation. Pain to palpation (i.e. tenderness) was scored from 0 to 3 according to the patients' response, and frequencies were calculated of pain to palpation scores for each site of the pericranial muscles. Results: Twelve patients among 218 TMD patients (5.5%) showed pain to palpation (scores of 1, 2) on the occipitalis or frontalis sites, and seven patients (3.2%) had moderate pain (a score of 2) to palpation. Among 218 TMD patients, there was only one patient whose primary symptomatic site of headache corresponded with the result of pain to palpation of the occipitofrontalis muscle. Conclusion: It can be concluded that examination with palpation of the occipitofrontalis muscle could be considered in the evaluation of TMD patients' headache symptom when other factors have been ruled out.

• Journal of Oral Medicine and Pain
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• v.36 no.3
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• pp.187-197
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• 2011

Temporomandibular disorders(TMD) is a collective term which is embracing a number of clinical problems that involve the masticatory musculature, the TMJ and associated structures, or both. Myofascial pain, which is a kind of masticatory muscle disorder of TMD, is the sensory, motor, and autonomic symptoms caused by myofascial trigger points. There has been some controversies regarding etiologies of TMD and MFP. Especially the issue of occlusal conditions has been a critical issue for long time. Despite much efforts, the results of studies regarding occlusal conditions were contradictory. These controversies might be mostly due to various factors resulting from the complex nature of TMD, however, inaccurate and inappropriate study design, selection criteria, methodologies also play significant roles. Recently, a computerized occlusal analysis system, T-Scan II which made it possible to reveal quantifiable time data and relative force data for analyzing occlusion, was introduced. Some authorities suggested that the concept of disclusion time and prolonged disclusion time of posterior tooth and MFP are related using T-Scan II. But the previous studies which used T-SCAN II are not reliable for they did not provide accurate diagnostic criteria of MFP. Morever they did not compare with controls, and had many other problems. The purpose of this study was to evaluate the relationship between MFP and prolonged disclusion time of posterior tooth, which is one of the occlusal factors of TMD, by selecting 30 subjects as the study group through strict criteria and comparing them with 38 controls using T-SCAN II, computerized occlusal analysis system. The results, statistically analyzed, are summarized as follows: 1. Cronbach ${\alpha}$ coefficient of repeated measurements of disclusion time was 0.92. 2. There were no statistically significant differences at repeated measured disclusion time of both side between control and study group. 3. There was no statistically significant diffefence in the disclusion time between right and left side. From the results above, we can suggest that there was no relationship between MFP and disclusion time, so irreversible treatments leading to the reduction of disclusion time for treating MFP would not be appropriate. However more controlled, large scaled study, which consider various occlusal factors, and quantification of symptoms using Helkimo index would be necessary in the future.

• Imaging Science in Dentistry
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• v.37 no.1
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• pp.15-18
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• 2007

Purpose : Disc and condylar position were observed on MRIs of temporomandibular joint disorder patients and condylar position agreement between MRI and tranascranal radiography was evaluated. Materials and Methods MRI and transcranial radiographs of both TM joints from 67 patients with temporemandibular disorder were used. On MRI, the position and shape of disc and condylar position as anterior, middle, posterior was evaluated at medial, center, and lateral views. On transcranial radiographs, condylar position was evaluated using the shortest distance from condyle to fossa in anterior, superior, and posterior directions. Results. 1. On MRI, 96 joints (71.6%) of 134 had anterior disc dispalcement with reduction and 38 joints (28.4%) without reduction. 2. Fourteen (14.6%) of 96 reducible joints showed anterior condylar position, 19 (19.8%) showed central position, 63 joints (65.6%) showed posterior position. Two joints (5.3%) of 38 non-reducible joints showed anterior condylar position, while 9 (23.7%) showed central position, and 27 (71.1%)-posterior position. 3. In 85 joints (63.4%) of 134, the transcranial condylar position agreed with that of the central MRI view, 10 joints (7.5%) with that of medial, 16 joints (11.9%) with that of lateral, and 23 joints (17.2%) disagreed with that of MRI. Conclusion : On MRT, most oi the reducible and non-reducible joints showed posterior condylar position. Transcranial radiographs taken with machine designed for TMJ had better agreement of condylar position with that of MRI. Extremely narrow joint spaces or very posterior condylar positions observed on transcranial radiographs had a little more than fifty percent agreement with those of MRIs.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.32 no.1
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• pp.23-32
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• 2023

A patient with para-functional habits can cause widespread teeth wear, along with temporomandibular joint disorders and myofascial pain syndrome in the masticatory muscles. Prolonged teeth wear is associated with a decrease in vertical occlusal dimension, leading to issues such as changes in facial morphology, decreased masticatory efficiency, and temporomandibular joint disorders. To achieve a three-dimensional full-mouth rehabilitation in patients with decreased vertical occlusal dimension, accurate diagnosis, analysis, and proactive treatment planning are essential. Prosthetic treatment accompanied by the restoration of physiological vertical occlusal dimension and the re-establishment of a normal occlusal plane is necessary. This case report presents a full-mouth rehabilitation case involving a patient with overall teeth wear, showing decreased vertical occlusal dimension which results in discomfort in the temporomandibular joint and aesthetic dissatisfaction. The report highlights the successful outcome achieved through the use of occlusal stabilization splint for temporomandibular joint stability and Gothic arch tracing devices for the re-establishment of intermaxillary relationships. Also, through adjustments and adaptation assessment using provisional prostheses, favorable outcomes were achieved both functionally and aesthetically.

• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.25-37
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• 2011

The purpose of this study is to investigate the relationship between personality type and symptoms and contributing factors of temporomandibular disorders. 199 college students completed the MBTI(Myers-Briggs Type Indicator) and a questionnaire and collected data were analyzed by SAS 9.2 program. The obtained results were as follows : 1. The prevalence of symptoms of temporomandibular disorders and mean scales of positive answers of contributing factors appeared to be higher in I type, S type, T type, P type than in E type, N type, F type, J type. 2. ISTP and ISFP among 16 types of personality seemed to have higher prevalence of symptoms and contributing factors of temporomandibular disorders than other types of personality. 3. Symptom of TMJ pain during mouth opening seemed to occur more frequently in I type, S type, F type, J type than in E type, N type, T type, P type. 4. Contributing factors including clenching and stressful state occurred significantly more frequently in I type than E type. Gum chewing habit occurred significantly more frequently in E type than in I type. 5. Unilateral chewing habit occurred significantly more frequently in J type than in P type. 6. Nervous or sensitive persons had significantly higher mean scales of positive answers of subjective symptoms than relaxed or general persons. 7. General persons had significantly lower mean scales of positive answers of contributing factors than nervous, sensitive and relaxed persons. In conclusion, these results show that there is the relationship between personality and temporomandibular disorders and patient education and counselling considering personality type may contribute to treating patients with temporomandibular disorders.

• Journal of Oral Medicine and Pain
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• v.32 no.2
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• pp.211-218
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• 2007

The purpose of this study was to compare the maximum bite forces between pre- and post-treatment related to specific diagnostic groups of TMD including masticatory muscle disorder (MMD), disc derangement (DD), joint inflammation (JI) and osteoarthritis (OA). Bite force between pre- and post-treatment was compared in 36 patients with unilateral TMD, successfully-managed in the Department of Oral Medicine, Dankook University Dental Hospital, for this study. The ratio of men to women was 7:29 and their mean age of $28.1{\pm}13.7$ years. The patients were categorized, through clinical and radiographic examination, into aforementioned 4 groups; MMD (N=18), DD (N=6), JI (N=5) and OA (N=7). The maximum bite force measurements were done at the antagonizing canines and 1st molars using a bite force recorder. Paired t-test, ANOVA, Multiple Comparison t-tests were used for statistical analysis. The results of this study showed that the maximum bite force before treatment increased after TMD treatment, which was noticeable at the canines (p=0.001 and p=0.000 for the affected and unaffected sides, respectively). In comparison related to the diagnostic groups of TMD, patients with osteoarthritis of TMJ exhibited the lowest strength while those with inflammatory disorder of TMJ had the highest strength on the affected sides. Increase of bite force after treatment was also found in each group. Significant difference between pre- and post-treatment was found at canines on the affected sides in MMD (p=0.045) and DD groups (p=0.009) while on the unaffected sides in OA group (p=0.003). Conclusively, the reduced bite force due to TMD could be recovered by conservative TMD treatment and that the difference of bite forces between pre- and post-treatment was noticeable at the canines.