• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.71-80
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• 2021

Background: The options for stabilization appliance therapy for masticatory muscle pain include soft occlusal and hard stabilization appliances. A previous study suggested that hard stabilization appliance therapy was effective for patients with local myalgia who developed long facets on their occlusal appliances. The objective of this study was to identify patients in whom a soft occlusal appliance should be used to treat masticatory muscle pain by analyzing the type of muscle pain present and patient factors that influenced the effectiveness of this treatment. Methods: The study included 42 patients diagnosed with local myalgia or myofascial pain according to the Diagnostic Criteria for Temporomandibular Disorders Diagnostic Decision Tree. The analysis of patient factors included variables believed to be associated with temporomandibular disorders. First, a temporary screening appliance was used for 2 weeks to assess each patient for bruxism during sleep. Soft appliance therapy was then started. For each patient, the effectiveness of the appliance was evaluated according to the intensity of tenderness during muscle palpation and the treatment satisfaction score at one month after starting treatment. Results: Data from 37 of the 42 patients were available for analysis. Twenty-five patients reported satisfaction with the appliance. In logistic regression analysis, the odds ratio for reduction of facet length was 1.998. Nineteen patients showed at least a 30% improvement in the visual analog scale score. The odds ratio for local myalgia was 18.148. Conclusion: Soft appliance therapy may be used in patients with local myalgia. Moreover, patients who develop short facets on the appliance surface are likely to be satisfied with soft appliance therapy. Soft appliance therapy may be appropriate for patients with local myalgia who develop short facets on their occlusal appliance.

• Journal of Oral Medicine and Pain
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• v.47 no.4
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• pp.217-221
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• 2022

Neurogenic muscular atrophy is muscle wasting and weakness caused by trauma or disease of the nerve that innervates the muscle. We describe a case of unilateral trigeminal neuropathy and neurogenic muscular atrophy of the masticatory muscle caused by a tumor in the foramen ovale. A 59-year-old man visited our clinic complaining of difficulty in right-sided mastication. There were no evident clinical signs and symptoms of temporomandibular disorder. However, severe atrophy of the right masseter and temporalis muscles and hypesthesia of the right side mandibular nerve area were confirmed. Through T1 and T2 signals on magnetic resonance imaging (MRI), a mass suspected of a neurogenic tumor was observed in the foramen ovale and cavernous sinus. Severe atrophy of all masticatory muscles on the right side was observed. This rare case shows trigeminal neuropathy caused by a tumor around the foramen ovale and atrophy of the ipsilateral masticatory muscles. For an accurate diagnosis, it is essential to identify the underlying cause of muscle atrophy with neurologic symptoms present. This can be done through a more detailed clinical examination, including sensory testing and brain MRI, and consider a referral to neurology or neurosurgery for the differential diagnosis of the intracranial disorder.

• Journal of Oral Medicine and Pain
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• v.35 no.4
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• pp.275-281
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• 2010

The lateral pterygoid muscle is one of the masticatory muscles basic to jaw function. Because of its deep location in the masticatory system, digital palpation of the muscle is usually difficult to perform and unreliable. Therefore, diagnosis of the myalgic disorders involving the lateral pterygoid muscle is a perplexing problem for clinicians. Local anesthetic injection can be a more effective method to examine the lateral pterygoid muscle for the purpose of discriminating the source of pain. Furthermore, immediate elimination of muscle pain facilitates stretching of the muscle in the full range. We report two cases of lateral pterygoid myalgia that were diagnosed and managed successfully through the use of intramuscular local anesthetic injection.

• Journal of Oral Medicine and Pain
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• v.45 no.3
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• pp.49-55
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• 2020

Purpose: This study investigated the association between the objective indicator of masticatory function assessment and the masseter muscle thickness (MMT) using ultrasound imaging. Methods: A total of 99 subjects (males: 24, females: 75, mean age: 76) were analyzed. The maximum bite force (MBF) was measured with a pressure-sensitive sheet and an image scanner. The mixing ability index (MAI) was calculated by image analysis after asking the subjects to chew a wax specimen. The MMT during rest and clenching were obtained with a diagnostic ultrasound system, and the difference in MMT during rest and MMT during clenching was defined as the difference in masseter muscle thickness (DMMT). Multiple regression analysis was performed to determine the independent variables affecting MBF and MAI. Results: The MBF showed correlation with the number of remaining teeth (β=0.346, p=0.002) and DMMT (β=0.251, p=0.011). The MAI correlated with only the number of remaining teeth (β=0.476, p<0.001). Conclusions: The DMMT reflects the state of masseter muscle contraction, and can be used as a predictor as well as the number of teeth when assessing masticatory function.

• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.53-67
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• 2013

This study was aimed to evaluate the masticatory efficiency after botulinum toxin type A (BTX-A) injection during 12 weeks using objective and subjective test. Also, we compared the difference of masticatory efficiency between group that injected into the masseter muscle only (M-group) and group that injected into the masseter and temporalis muscle (M-T group). The mixing ability index (MAI) was used as the objective indicator, and visual analogue scale (VAS) and food intake ability (FIA) index were used as the subjective indicators. It was concluded that masticatory efficiency was significantly lowered after a BTX-A injection into the masticatory muscle, but it gradually recovered in a predictable pattern by the 12 weeks. The disturbance of subjective masticatory efficiency was lasted longer than objective masticatory efficiency. The masticatory efficiency was lower in M-T group than M group. It was statistically significant in the VAS and FIA at 4 weeks, but the MAI showed no significancy. After 4weeks, there was rapid recovery of muscle function in M-T group, and the difference between two groups was not significant. It could be concluded that there will be no serious disturbance of mastication compared to injection is done only into the masseter muscle, even if injection is done into the masseter and temporalis muscle in dose of this study. According to the food properties, it was confirmed that people feel more discomfort on taking hard and tough foods after BTX-A injection and not only hard foods, but also intake of soft and runny foods were influenced by botulinum toxin injection.

• Journal of Oral Medicine and Pain
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• v.45 no.4
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• pp.120-123
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• 2020

The causes of tongue pain and discomfort include systemic disease, malnutrition, mental illness, fungal infection, and neuropathy. Three postmenopausal women reported burning sensations and stiffness of the tongue for various periods, from one month to four years. There were no objective etiological factors to cause the tongue pain and discomfort. Muscular tenderness upon palpation of masticatory muscles, sternocleidomastoid, trapezius, and tongue were observed. Physical therapy approaches such as moist hot pack, ultrasound, and myomonitor were performed on three patients with tongue pain, just as for temporomandibular joint disease. Additional botulinum toxin injection therapy was applied to one patient who displayed a clenching habit. All three patients showed a marked improvement in their tongue symptoms after the muscle relaxation and botulinum toxin injection therapy.

• 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.

• The Transactions of the Korean Institute of Electrical Engineers D
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• v.50 no.5
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• pp.247-254
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• 2001

Silent period(SP) is transient stops of muscle activity that are induced by mechanical or electrical stimulus and the duration of silent period is a important parameter that have been associated with symptoms of masticatory dysfunction. Muscle fatigue is induced by sustained muscular contractions. It is associated with the external manifestations as the inability to maintain a desired force output, muscular tremor, and localized pain. Muscle fatigue is a parameter that have been measured or monitored the deterioration of a performance of muscles. On the study of relationship between SP and masticatory muscle fatigue, Nagasawa suggested that SP increases up to 3 min. from the beginning of clenching when the subjects performed sustained contractions at 50% maximum clenching level. In this paper, in order to evaluate a relationship between SP and muscle fatigue, 10 SPs per 1 minute are measured at 10%, 20%, 50% maximum clenching level. We used the median frequency in order to quantify the degree of muscle fatigue. However, the results shows that the duration of silent period was not significantly affected by differing levels of muscle fatigue. Therefore, we suggest that the SP is not increased or decreased as the results of muscle fatigue, also the origin of the SP generation mechanism is discussed.

• Journal of Oral Medicine and Pain
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• v.14 no.1
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• pp.113-121
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• 1989

In this study, 94 patients with temporomandibular disorders were interviewed to evaluate the effect of the treatment they received at the department of Oral diagnosis and oral Medicine in Seoul national university Hospital. The treatment administered to the patient were patient education, relaxation procedures, physical therapy, occlusal splint therapy and selective grinding of teeth. The following results were disclosed : 1. 97.9% of the patients reported no pain or considerably less pain than they had reported at their first visits to the department. 2. 89.3% of the patients thought that the treatment provided was either complete or considerably successful. 3. TMJ and facial pain was resolved within average 3.0 months 4. Of the 70 patients who previously reported having jaw joint sound, 34 patients (48.6%) no longer reported int. 5. Of the 48 patients who previously reported having headache regularly, 3 patients (68.8%) no longer reported headache regularly. 6. Of the 66 patients who previously reported having masticatory muscle pain, 41 patients (62.1%) no longer reported masticatory muscle pain. 7. Analysis of the data did not disclose a subgroup or factor, such as age, the stage of internal derangement, capsulitis, bruxism, MPD, duration of symptoms, that could be correlated with the reduction of pain or the patient's perception of success of treatment.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.161-174
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• 2013

This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into four group; saline injection group (n=10), lidocaine injection group (n=10), morphine 1.5 mg injection group (n=10) and morphine 3 mg injection group (n=10). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 1 hour, 24 hour, 48 hour and then it was analyzed statistically. The results were as follows : 1. The subjective pain evaluation were significantly different statistically in morphine 3 mg group after 48 hour. (VAS: p<0.01, MGQ: p<0.001, PD: p<0.05) 2. The objective pain evaluation were significantly different statistically in morphine 1.5 mg group after 1 hour. (PPT: p<0.01, PPTol: p<0.05) 3. The morphine 3 mg group were more significantly different than lidocaine group and morphine 1.5 mg group statistically in the McGill pain questionnaire evaluation. (1h: p<0.01, 24h: p<0.01, 48h: p<0.001) Therefore, it was revealed that the morphine 3 mg injection was effective to pain control for masticatory muscle pain patients within 48 hours and more effect than lidocaine injection.