• The Journal of Korean Academy of Prosthodontics
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• v.32 no.1
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• pp.103-119
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• 1994

The purpose of this study was to evaluate the mandibular movements of TMD patients comparing to normal persons. Sirognathograph was used to measure five parameters of mandibular movements of twenty normal persons and eight TMD patients. Five parameters were (1) Maximum opening during maximum opening and closing, (2) Mean velocity during maximum opening and closing, (3) Maximum opening during unilateral chewing, (4) Mean velocity during unilateral chewing, (5) Consistency of mandibular movement during unilateral chewing. Based on above results, new Mandibular Movement Index(M.M.I.) was formulated and compared to Helkimo's Clinical Dysfunction Index by measuring two indices before treatment and 2 weeks, 4 weeks, 6 weeks, 8 weeks after treatment. The conclusions were as follows: 1, The amounts of maximum opening and mean velocity during maximum opening and closing of TMD patients were less than those of normal persons(p<0.01). 2. The amounts of maximum opening and mean velocity during unilateral chewing of TMD patients were less than those of normal persons(p<0.05) (P<0.01). 3. Although TMD patients showed limited mandibular movements during unilateral chewing, the consistency of mandibular movements was better than that of normal persons(p<0.05). 4. Both mandibular movement index and Helkimo's Clinical Dysfunction Index, were useful in diagnosing TMD patients.

• Journal of Oral Medicine and Pain
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• v.39 no.3
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• pp.100-106
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• 2014

Purpose: This study was performed to investigate the relationship between temporomandibular disorders (TMDs) and the asymmetry of the mandibular height. Methods: We compared 100 randomly selected TMD patients diagnosed by the research diagnostic criteria for TMD (RDC/TMD) Axis I with 100 non-TMD control subjects matched with the TMD patients in age and gender. The mandibular heights were measured on an orthopantomogram and the asymmetry index (AI) was calculated as previously described. Results: The absolute AI value of 4.37% turned out to be the least cut-off value defining asymmetry, which showed a significant difference in asymmetry incidence (p<0.01) between the TMD and control groups. The risk of TMD increased in the asymmetry group by 4.57 (odds ratio). The incidence of asymmetry was not related to age and gender in both of the TMD and control groups. When dividing the TMD group according to the RDC/TMD Axis I diagnosis, neither the incidence of muscle disorder nor disk displacement was related to the incidence of asymmetry. However, a higher incidence of asymmetry was observed in the subjects classified into the arthrosis/arthritis groups (p<0.01). Conclusions: Although it does not imply a direct cause-and-effect relationship, asymmetry resulting in more than 4.37% difference between mandibular heights may increase the risk of TMD and correlates positively to the incidence of arthritic change in the temporomandibular joint of TMD patients.

• Journal of Yeungnam Medical Science
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• v.13 no.2
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• pp.308-323
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• 1996

This study tried to find the prevalence and distribution of temporo-mandibulr disorders(TMD) for workers (employee) in Seoul area to investigate the correlation between TMD and possible etiological factors such as general muscle and joint symptoms, headache, unilateral chewing and parafunction. This study was an epidemiological investigation of answers obtained from 282 persons by questionaire from Aug. 1995 to Nov. 1995. The major findings from the questionaire were as follows. (1) 43.26% of the subjects(282 persons) has TMD. (41.88% of man and 43.26% of women) (2) The more often people have general muscle and joint symptoms and headache, the more susceptible they are to TMD. Their correlation was very significant(p<0.001). (3) The more people have bad oral habits such as bruxism, clenching and biting habit, the more likely they have TMD. The more sensitive people are to stress, the more frequently they have bad oral habits such as bruxism, clenching and biting habit. (4) Unilateral chewing has higher TMD index than bilateral chewing. There is no relationship between ache areas and TMD index.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.5
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• pp.375-380
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• 2009

Objective : Trauma has been a controversial issue although it has been considered to be a major factor for the temporomandibular disorder(TMD). We evaluated the relationship between macrotrauma or microtrauma and TMD. Methods : This study was performed in patients with TMD undergoing treatment at SNUBH from October 2006 to January 2007. Sixty one male patients and 166 female patients(total 227) were included and the average age was 34 years(ranging from 14 to 85 years). We investigated the possible etiologic factors, diagnosis and treatment with the review of medical records and radiography. Chronic pain, depression, somatic score(including pain item), somatic score(excluding pain item) were evaluated on the basis of diagnostic index from the Research Diagnostic Criteria on TMD. Results : Eighteen patients(7.9%) out of 227 patients suffered from TMD as a result of macrotrauma. Ninety four(41.4%) patients had microtrauma and six patients(2.6%) had both macro- and microtrauma(etiologic factor). The main symptoms included pain. joint noise and mouth opening limitation while the other symptoms were headache and tinnitus. The patients had suffered from TMD for average 41 weeks (ranging from 1 to 480 weeks). 116 patients took splint as a major treatment. As a prognosis, 19 patients(8.4%) recovered completely. 26(11.0%) had improvement and 181(80%) had persistent symptoms. 1 patient(0.4%) underwent an arthroplasty. Diagnostic index from RDC chart showed that macrotrauma was the highest score(except depression score) among the other etiologic factors. Conclusion : This study showed that macro- and microtrauma can be considered to be the major etiologic factors of TMD, which also affect the chronic, depression and somatic discomfort.

• Journal of Oral Medicine and Pain
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• v.14 no.1
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• pp.25-34
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• 1989

The author performed on epidemiological study of the TMD in 189 elderly people and 195 young people with Helkimo index. The clinical dysfunction index was based on data from clinical examination and the anamestic dysfunction index was based on data from the interview with the investigated person. The results were as follows : 1. In the elderly population, 27.5% reported that they had subjectively symptom of TMD but 43.4% had sign and symptoms of TMD in clinical examination. 2. The mean values for maximal opening differed significantly between elderly and young populations, 47.22mm and 51.44mm (p<0.001) and less than a 40mm opening was observed 7.9% in elderly population, 0.5% in young population (p<0.001). 3. The mean values for lateral movement to the right and left did not differ with age, which were 8.56mm and 8.47mm in elderly population, 8.90mm and 8.81mm in young population, but the mean value for protrusion differed significantly between elderly and young populations, 6.89mm and 7.64mm (p<0.01). 4. A higher incidence of TMJ noise was recorded in the elderly and young populations than young population, especially crepitus, but a higher incidence of clicking was recorded in young population (p<0.05).

• Journal of Oral Medicine and Pain
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• v.45 no.3
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• pp.56-64
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• 2020

Purpose: Temporomandibular disorders (TMD) is a mosaic of clinical signs and symptoms that can be regarded as a set of phenotypes that are affected by various factors including pain sensitivity, pain disability, sleep and psychological functioning. The aims of this study were to evaluate association of pain experience, sleep quality and psychological distress with different phenotypes of TMD patients. Methods: This retrospective study included a cohort (n=1,858; 63.8% for female, mean age=34.9±15.9 years) of patients with TMD. A set of self-administered questionnaires concerning pain interference (Brief Pain Inventory), pain disability (Graded Chronic Pain Scale), sleep quality (Pittsburg Sleep Questionnaire Index), psychological distress (Symptom Checklist-90 revised), and pain catastrophizing (Pain Catastrophizing Scale) were administered to all participants at the first consultation. All TMD patients were classified into four groups including TMD with internal derangement without pain (TMD_ID, n=370), TMD with joint pain (TMD_J, n=571), TMD with muscle pain (TMD_M, n=541) and TMD with muscle-joint combined pain (TMD_MJ, n=376). Results: The female ratio was particularly high in the group with TMD_MJ (p=0.001). The patients with muscle pain and both muscle and joint pain had longer symptom duration (p=0.004) and presented significantly higher scores in pain experience (p<0.001), subjective sleep quality (p<0.001), pain catastrophizing (p<0.001) and psychological distress (p<0.05) except for paranoid-ideation than the groups with only joint problems. Conclusions: The results of this study highlight the importance of multi-dimensional approach that consider pain disability, sleep quality, and psychological functioning in the management of TMD with muscle component. This study would contribute to a better understanding of interaction between heterogeneous TMD and multiple risk factors in order to build tailored treatment based on different phenotypes.

• Journal of Oral Medicine and Pain
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• v.45 no.2
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• pp.23-28
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• 2020

Purpose: Temporomadibular disorders (TMDs) can result in chronic pain, which is often associated with psychological and sleep disturbance. Increased levels of psychological and sleep impairments are often related with poor treatment outcomes. The purpose of the present study was to evaluate clinical features, psychological profiles and the prevalence of clinical insomnia in TMD patients with chronic pain and to suggest an effective treatment approach. Methods: A total of 200 TMD patients who had visited the Pusan National University Hospital dental clinic for treatment of their pain were recruited from June 2018 through December 2019. TMD patients were classified into an acute (n=100) and chronic (n=100) group and compared the clinical symptoms. The primary diagnosis of TMD were categorized as TMD with joint pain group (TMD_J), TMD with muscle pain group (TMD_M) and TMD with joint-muscle mixed pain group (TMD_JM). Self- report measures of sleep quality and psychological profiles were evaluated via the Insomnia Severity Index (ISI) and the Korean Stress Response Inventory (SRI). Independent t-tests, Mann-Whitney U-tests, and chisquared test were used for the statistical analysis. Results: Chronic TMD patients showed higher pain intensity, as well as higher prevalence of related symptoms (headache, musculoskeletal pain) and myogenous pain. They also had significantly higher scores in all SRI parameters and a higher percentage of clinical insomnia than acute TMD patients. Conclusions: Based on the above results, psychological profiles and sleep quality assessments are necessary to provide essential data that will allow for improved treatment of chronic TMD patients.

• Journal of Oral Medicine and Pain
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• v.40 no.4
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• pp.155-162
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• 2015

Purpose: The association between pain and sleep is described as a vicious cycle and psychological distress is well known as comorbid condition in the patients with pain and sleep problems. The aim of the study was to evaluate the prevalence of self-reported sleep disturbance and its relationship to clinical and psychological profiles in temporomandibular disorder (TMD) patients. Methods: The sample consisted of 123 TMD patients (90 women and 33 men), with a mean age of $39.9{\pm}15.4years$. Self-report measures of sleep quality, pain and psychological profile were conducted via the Pittsburgh Sleep Quality Index (PSQI), the Brief Pain Inventory and the Symptom Checklist-90-Revision at the initial visit. The primary diagnosis of TMD were categorized as TMD with internal derangement without pain, TMD with joint pain, TMD with muscle pain and TMD with joint-muscle combined pain. The chi-square test, independent t-test, oneway ANOVA and multiple linear regression analysis were used for statistics. Results: The patients was grouped as good sleepers (n=32, scores of 5 and lower) and poor sleepers (n=91, scores of 6 and higher) according to the recommended cutoff point of the global PSQI score (>5). TMD patients with pain showed poor sleep quality than TMD patients with internal derangement without pain. Poor sleepers had high pain interference and elevated psychological distress. Among them, pain interference and depression were significant predictors to sleep quality. Conclusions: The results suggest that sleep disturbance is a prevalent complaint in TMD patients, and sleep problems in TMD patients are associated with pain and psychological distress.

• Journal of Korean Dental Science
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• v.8 no.1
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• pp.1-9
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• 2015

Purpose: To evaluate the effectiveness of temporomandibular joint (TMJ) disorder follow-up and determine the factors that affect the TMJ bone scan hot spot numerical value (bone scan value), and to compare this value to the diagnosis of patients with temporomandibular joint disorders (TMD), their treatment options, and the resolution of their symptoms. Materials and Methods: A retrospective cohort study was performed on 24 patients (four males, 20 females) who received TMD treatment in the Section of Dentistry, Seoul National University Bundang Hospital (Seongnam, Korea) from 2007 to 2014. An analysis of the significance test and correlation between TMD diagnosis, treatment options, a baseline the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire, treatment before and after the clinical examination and subjective progress, and TMJ bone scan value change were completed by using SPSS version 12.0. Result: Although only 14 patients had bony factors that caused TMD, the average pre-treatment bone scan value of the all patients was $4.29{\pm}0.31$, which is higher than the finding for osteoarthritis (3.88), and reduced post-treatment bone scan value was found to be without a statistically significant difference (P=0.056). After the treatments, clinical symptoms in 18 patients disappeared, and six patients did not require additional treatment, although they still displayed subjective symptoms. It was observed that the higher the pre-treatment bone scan value, nonspecific physical symptoms, chronic pain index, characteristic pain intensity, disability score, were, the lower the post-treatment bone scan value was. And this reduced post-treatment bone scan value tendency was not shown with the pre-treatment depression index, but there was not a statistical difference. Conclusion: The post-treatment TMJ bone scan value tended to be insignificantly reduced in the 24 patients whose clinical symptoms were improved (P=0.056). Moreover, the TMJ bone scan value showed no relation to the TMD type or its related symptoms.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.6
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• pp.326-331
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• 2012

Objectives: Stress may have an impact on treatment types that patients receive for temporomandibular disorders (TMDs). This study sought to investigate the relationship between the stress index and type of treatments in patients with TMD. Materials and Methods: The psychosocial well-being index-short form (PWI-SF) was used to evaluate stress levels in ninety-two patients with TMD. Treatment types were classified into two groups: one group received counseling, physical therapy or medication, while the second group received splint therapy or surgical intervention. Results: The high-risk group (PWI-SF${\geq}27$, the higher the points, the more severe the stress level) was more frequently treated by splint therapy than the low-risk group (PWI-SF<27). Female TMD patients reported higher PWI-SF scores than male TMD patients. Conclusion: This study suggests a relationship between stress levels and treatment types for patients with TMD. Thus, the appropriate evaluation and management of stress could be an important factor in treating TMD.