• 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.

• The Journal of the Korean dental association
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• v.53 no.9
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• pp.602-609
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• 2015

The aim of this document is to evaluate the effect of bite balance on physical fitness and motor capacity to determine the importance of the occlusal stability as a possible action mechanism of occlusal appliance including mouthguards on physical performances. We all remember that day when the prominent athlete was in the news wearing a mouthguard to improve human athletic performance. I once had investigated the determinants of athletic performance in all sorts of sports. Most of the studies had overinterpretation of results and lack of evidence to support the information. However, I discovered great expectations for new possibility in this field and settled for a more academic approach to this intriguing subject. The followings are some examples of the subject 1. Archers who wore occlusal appliances to increase the vertical dimension of occlusion by 2~3mm increased their ability to focus and to maintain good sense of balance. Their accuracy rate has been improved. The appliance was made of acrylic resin (a type of plastic). 2. Canoe players who wore occlusal appliances to increase the vertical dimension of occlusion by 5mm surpassed longtime competitor and won the race with 10 seconds gap. 3. A cycle rider who wore an occlusal appliance to treat his malocclusion surpassed his old record from 10.8 seconds to 10.3 seconds. His muscle reflexes (anaerobic exercise) and endurance (aerobic exercise) has been enhanced. 4. Occlusal appliances had a good effect on athletic performance in most sports such as swimming, diving, and weightlifting. As for the clenching on dentition, people clench their teeth when they push their physical and mental limits during sports activities. Clenching can be induced by physical exertion when maximum muscle strength is retained and this is similarly found in different types of exercises. In addition, restraint of respiratory function is observed. Therefore, creating a occlusal balance with occlusal appliance or mouthguard promoted a favorable influence when an athlete clenches.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.375-381
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• 2007

Occlusal stabilization appliance is one of the most common treatment option for management of temporomandibular disorders. It acts in oral cavity for several hours per day, and usually it will take at least 6 months to 2 years of total wearing periods to take a treatment goal. In the oral cavity, occlusal stabilization appliance, unintentional manner, is able to acts as a reservoir of bacteria and protect bacteria from saliva and oxygen. This condition is so favorable to many bacteria such as S. mutans and other anaerobes, usually have been reported as causative factors of dental caries, periodontal disease and oral malodor. In this study, we investigated anaerobic bacteria and S. mutans count before and after occlusal stabilization appliance use to evaluate the possible role of occlusal stabilization appliance as protector of these bacteria. Four men(average 27.5 years) wore maxillary occlusal stabilization appliance at each night(average 9 hours) for 5 days. we swabbed saliva-plaque mixed sample at 3 different site(maxillary left 2nd molar, maxillary left central incisor, mandibular left 2nd molar) before and after occlusal stabilization appliance use. Each samples were plated in (1) anaerobic blood agar medium, (2) selective S. mutans medium(MS-MUTV) and incubated in anaerobic chamber($CO^2$ 10%, $37^{\circ}C$) for 72 hours. Each bacterial colony forming unit(CFU) were counted with naked eyes. From obtained data, we can conclude as follows: 1. There was some changes about anaerobic bacteria and S. mutans count in oral cavity after occlusal stabilization appliance use. 2. The number of anaerobic bacteria was significantly increased at maxillary 2nd molar(P=0.003), maxillary central incisor(P=0.020) after occlusal stabilization appliance use compared with before. 3. Occlusal stabilization appliance use itself had indirect effect to increase the number of anaerobic bacteria at other uncovered opponent tooth site. 4. The number of S. mutans was significantly increased at maxillary 2nd molar(P=0.043), maxillary central incisor (P=0.049) after occlusal stabilization appliance use compared with before. 5. Occlusal stabilization appliance use itself had not any effect on the number of S. mutans at other uncovered opponent tooth site.

• The Journal of the Korean dental association
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• v.57 no.5
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• pp.270-278
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• 2019

Oral appliances therapy is becoming increasingly recognized as a successful treatment for snoring and obstructive sleep apnea(OSA). Compared with continuous positive airway pressure(CPAP), the gold standard therapy for OSA, oral appliance therapy are less efficacious for severe OSA but are more acceptable and tolerable for patients, which in turn, may lead to a comparable level of therapeutic effectiveness. Nevertheless, the various side effects of oral appliance therapy, such as, increased salivation or dryness, pain or discomfort in the teeth or gums, occlusal discomfort in the morning, temporomandibular disorders, dental and occlusal changes may cause discontinuation of treatment or changes in treatment plan. Therefore, oral appliance therapy should be provided by a qualified dentist who can evaluate oral tissues, occlusion, and temporomandibular joints, and prevent and manage the possible side effects.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.1
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• pp.13-19
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• 2010

Bruxism is nonfunctional jaw movement that includes clenching, grinding and gnashing of teeth. It usually occurs during sleep, but with functional abnormality of brain, it can be seen during consciousness. Oromandibular dystonia (OMD) can involve the masticatory, lower facial, and tongue muscles and may result in trismus, bruxism, involuntary jaw opening or closure, and involuntary tongue movement. Its prevalence in the general population is 21%, but its incidence after brain injury is unknown, Untreated, bruxism and OMD cause masseter hypertrophy, headache, temporomandibular joint destruction and total dental wear. We report a case of successful treatment of bruxism and OMD after brain injury treated with botulinum toxin A and occlusal appliance. The patient was a 59-year-old man with operation history of frontal craniotomy and removal of malformed vessel secondary to cerebral arteriovenous malfomation. We injected with a total 60 units of botulinum toxin A each masseteric muscle and took impression for occlusal appliance fabrication under general anesthesia. On follow up 2 weeks and 2 months, the patient remained almost free of bruxism. We propose that botulinum toxin A and occlusal appliances be considered as a treatment for bruxism and OMD after brain injury.

• The Journal of the Korean dental association
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• v.51 no.2
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• pp.84-91
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• 2013

Temporomandibular joint disorder(TMJD) was mainly characterized with joint pain, motion limitation, joint sound, resulted from pathologic conditions in temporomandibular joint and around tissue. As temporomandibular joint is one of decisive factors determining the occlusion, disorders in temporomandibular joint may cause the occlusal changes. The causes of occlusal changes related with TMJD can be classified into 2 categories; (1) those related to progression of disorder, 2) those related to treatment of the disorder. The clinical manifestation of occlusal changes depend on their causes and affected site. Therefore, whenever possible, treatment should be directed to the relief of the underlying causes, However, it is not always possible to relieve the underlying conditions. Moreover, some occlusal changes may remain irreversible even after the considerable improvement in clinical symptoms. Regarding the treatment of the permanent occlusal changes, it has been reported that the extensive occlusal treatment including occlusal adjustment, prosthodontic treatment, orthodontic treatment should be applied. Here, we present with a case report of occlusal change caused by the progressive temporomandibular joint disorder, together with introducing the intermaxillary traction appliance as the possible treatment option.

• Journal of Oral Medicine and Pain
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• v.41 no.3
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• pp.110-117
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• 2016

Purpose: The purpose of this study is to determine factors influencing the duration of occlusal appliance (OA) treatment for patients with temporomandibular joint (TMJ) internal derangement. Methods: Ninety patients were included for this study, who satisfied the following including criteria: (i) those who were diagnosed as disc displacement of TMJ by taking magnetic resonance imaging (MRI) and (ii) those who were finished OA treatment. The subjects were classified into three groups according to the period of OA treatment: (i) early response group (<6 months), (ii) moderate response group (6 months-1 year), and (iii) delayed response group (>1 year). Demographic data, data from chief complaints and past history of temporomandibular disorder, data from clinical examination and diagnostic imaging including panoramic view and TMJ MRI were compared among groups. One-way ANOVA and chi-square analysis were used to test statistical significance. Results: There were no significant differences in demographic data, data from chief complaints and TMJ imaging. However, only the prevalence of oral parafunctional habits including bruxism, clenching, and unilateral chewing showed significant differences among groups. Conclusions: Oral parafunctional habits could be factors to influence the duration of OA treatment in the patients with TMJ internal derangement.

• Journal of Oral Medicine and Pain
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• v.30 no.3
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• pp.361-373
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• 2005

Occlusal appliance therapy has been proven to be very useful and effective in reducing signs and symptoms of patients with TMD. However, there are no reports about the masticatory efficiency of the occlusal appliance. The purpose of this study was, first, to investigate the masticatory efficiency of the conventional stabilization appliance experimentally in normal healthy subjects, by comparing it with that of their natural dentition; and, second, to develop a modified stabilization appliance as an attempt to increase masticatory efficiency. Eleven subjects (mean age 25.3 years, range from 23 to 33) participated in this study. Six were men and five were women. They were healthy and had complete or near―complete natural dentition, and did not present with signs or symptoms of TMD. Two kinds of occlusal appliances―the conventional flat maxillary stabilization appliance (i.e., FSA) and a modified maxillary stabilization appliance with additional anatomic structures on its occlusal surface (i.e., ASA)―were made for every subject. Subjects chewed peanuts that were selected as a food to test the three masticatory conditions of the natural dentition, the ASA, and the FSA. The number of chewing strokes was counted during each 1-minute chewing period. Chewed peanut boluses were recovered and their hardness was measured by texture analysis. Statistical tests were performed. The following results were obtained. 1. The masticatory efficiency of the FSA was 38.6 percent that of the natural dentition. The efficiency of the ASA was 78.2 percent that of the natural dentition. 2. The number of chewing strokes in the natural dentition condition was measured to be 1.5 strokes per second. It decreased to 90 percent in the ASA and FSA conditions. These results indicate that the ASA could serve an improved masticatory capacity as well as its therapeutic effects in TMD. A clinical application of the ASA should be considered to extend the management of TMD patients.

• Journal of Oral Medicine and Pain
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• v.35 no.1
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• pp.75-81
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• 2010

By repeating nocturnal bruxism occlusal appliance's wearing condition that is used to cure temporomandibular disorders into the vitro experiment, research aims to find out how moisture infiltrated and drying cycle process affects on the surface microhardness of the resin for occlusal appliance and flexural strength. By utilizing resin for occlusal appliance which is the main component of poly methyl methacrylate, bar shaped sample was produced. For the resin sample utilized as the controlled group 1, the sample was infiltrated in the moisture for 7 days in the temperature of 37C. Then, the resin sample of the controlled group 2 was maintained in a dry condition for 7 days in the normal temperature. After that, each sample's surface microhardness and flexural strength were measured. For the resin sample that is utilized as the experimental sample, the sample was infiltrated in the moisture for 7 days in the temperature of 37C. Then, it was inundated for 8 hours a day and dried in the normal temperature for 16 hours with the continuous process of moisture infiltration and dry cycle process for 30 days. During this cycle process, sample's surface and flexural strength were measured in the 1st day, 7th day, and 30th day. Then, it was statistically analyzed to find out the difference of controlled and experiment group's surface microhardness and flexural strength. Results are 1. For the experimental and controlled group's surface microhardness of the resin for the occlusal appliance, it did not show any significant differences after moisture infiltration and dry cycle process repetition. 2. In case of the flexural strength for resin for the occlusal appliance, experimental group with moisture infiltration and dry cycle for 30 day process had greater effect than the experimental group at the 1st day and controlled group These results can be considered to be utilized from the patients of the temporomandibular disorders towards occlusal appliance used and maintained method.

• Journal of Oral Medicine and Pain
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• v.43 no.4
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• pp.112-117
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• 2018

Purpose: The aim of this study is to compare the short-term effectiveness of hard and soft stabilizing appliances (H-A and S-A) in treating patients with acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Methods: Eighty one patients diagnosed as acute TMJ DDwoR at oral medicine of Chosun University Dental Hospital from November 2016 to September 2017 were included in this study. The subjects were divided into three groups: The control group (34 patients treated without occlusal appliance), the H-A group (31 patients treated with H-A) and the S-A group (16 patients treated with S-A). The pain intensity using Visual Analog Scale and maximum mouth opening (MMO) were evaluated every week for 8 weeks. Results: The improvement of the pain intensity and MMO in the H-A group and the S-A group compared with the control group were noted (p<0.05). Conclusions: This study suggests that hard and S-As may be equally useful in treating patients with TMJ DDwoR. S-A could be recommended to reduce the symptoms of TMJ DDwoR in short period.