• Journal of Oral Medicine and Pain
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• v.44 no.3
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• pp.92-102
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• 2019

Purpose: To investigate the masticatory function of patients with different temporomandibular disorders (TMD) phenotypes, and to explore the risk factors for the masticatory function of TMD patients among multiple biopsychosocial variables using patient-reported outcomes (PROs). Methods: Clinical features and TMD diagnoses of 250 cases were investigated by reviewing medical records. Psychosocial factors were evaluated using four questionnaires representing pain severity and pain interference (Brief Pain Inventory), pain catastrophizing (Pain Catastrophizing Scale, PCS), psychological distress (Symptom Check List-90-Revised, SCL-90R) and kinesiophobia (Tampa Scale for Kinesiophobia for Temporomandibular Disorders, TSK-TMD). Masticatory function, as a dependent variable, was determined using the Jaw Functional Limitation Scale (JFLS). Kruskal-Wallis test and Spearman's rank correlation were used for analyses. Results: A total of 145 cases were included and classified into four subgroups including group 1: TMD with internal derangement without pain (n=14), group 2: TMD with muscle pain (n=32), group 3: TMD with joint pain (n=60) and group 4: TMD with muscle-joint combined pain (n=39). Pain severity (p=0.001) and interference (p=0.022) were the highest in group 2, but the mean global score of JFLS was the highest in group 3, followed by group 4, group 2, and group 1 (p=0.013). Pain severity, pain interference, the mean global score of PCS and the mean global score of TSK-TMD showed significant and moderate correlation with the mean global score of JFLS. All subdimensions and the global severity index of SCL-90R had significant, but weak correlations with all scores of JFLS. Conclusions: The results suggest that masticatory functional limitation depends on the TMD phenotypes. Among the various PROs, pain perception, pain catastrophizing and kinesiophobia seem to be more influential risk factors on jaw function than psychological distress, such as depression and anxiety.

• The korean journal of orthodontics
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• v.27 no.4 s.63
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• pp.523-538
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• 1997

In order to investigate TMD prevalence in malocclusion patients and to study its relationship with occlusal factors, 205 malocclusion patients (M67, F138, 6Y1M-46Y8M) were examined. The following examinations were carried out, Questionnaire personal history, TMD symptoms, and the associated factors Clinical examination : TMJ sound and maximum mouth opening Orthopantomogram : condyle abnormalities, length of Co'-Inc' and Co'-Go', ratio Co'- Inc'/ Co'-Go', and depth of antegonial notch Transcranial view limitation of anterior movement of condyle Model Angle classification, overjet, overbite, midline discrepancy, missing of posterior teeth, posterior crossbite, attrition of palatal cusp of maxillary molars, crowding/spacing The results could be summarized as follows, 1. The prevalence of TMD showed that Helkimo Anamestic Inder(Ai) 0 was $46.8\%$, Ai I was $22.0\%$, Ai II was $31.2\%$ and subjective symptoms increased with aging (p<0.001) and were frequent in females (p<0.05). 2. Flattening ($4.4\%$) was the most frequent condyle abnormality on Orthopantomogram, and $8.3\%$ of subjects showed some abnormalities on Orthopantomogram. 3. The cases with neck and shoulder pain (p<0.001), clenching, lip biting (p<0.01), and headache (p<0.05) showed higher scores of Ai. 4. Angle class II showed high frequency of condylar abnormalities on Orthopantomogram, and subjects whose palatal cusp of maxillary molars had been attrided had the tendency to show high hi scores (p<0.05). The other occlusal factors had nothing to do with the symptoms of TMD. 5. In the cases that 1)the value of Co'-Inc', Co'-Go' or Co'-Inc'/Co'-Go' were low or 2)the differences of Co'-Go' or Co'-Inc'/Co'-Go' between the right and the left were large, condylar abnormalities were frequently obserbed on Orthopantomogram.

• Journal of Oral Medicine and Pain
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• v.48 no.3
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• pp.87-95
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• 2023

Purpose: To quantify the relationship between perceived pain intensity and psychological variables in a sample of participants with temporomandibular disorder, with or without central sensitization (CS). Methods: A cross-sectional study with nonprobability convenience sampling was conducted from January 1, 2022, to June 30, 2023. Pain intensity (Numeric Pain Rating Scale), anxiety (State-Trait Anxiety Questionnaire, STAI), catastrophizing (Pain Catastrophizing Scale, PCS), perceived stress (Perceived Stress Scale, PSS), and sleep quality (Pittsburgh Sleep Quality Index, PSQI) were assessed. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Co.), which included descriptive and normality analyses and the calculation of strength of multiple correlational regression. Results: A total of 52 (n=34 female 65.4%; n=18 male 34.6%) subjects with diagnosis of temporomandibular disorders (TMD) were finally included. A total of 26 participants (n=26, 50.0%) were cases suffered from CS (TMD-CS mean=46.62±11.24) while the remaining participants (n=26, 50.0%) were the controls (TMD-nCS mean=26.77, standard deviation [SD]=8.42). The pain intensity was moderate in both groups TMDCS (mean=7.62, SD=0.83) and TMD-nCS (mean=7.05, SD=0.86), anxiety (TMD-CS STAI mean=53.27, SD=11.54; TMD-nCS STAI mean=49, SD=11.55), catastrophizing (TMD-CS PCS mean=46.27, SD=9.75; TMD-nCS PCS mean=26.69, SD=4.97), perceived stress (TMDCS PSS mean=30.35, SD=4.91; TMD-nCS PSS mean=26.12, SD=6.60) and sleep quality (TMD-CS PSQI mean=15.81, SD=3.65; TMD-nCS PSQI mean=12.77, SD=2.76) levels were measured in both groups. In TMD-CS and TMD-nCS, higher anxiety levels were moderately and significantly associated with greater pain intensity β=0.4467 (t=2.477, p=0.021) and β=0.5087 (t=2.672, p=0.014). Nevertheless, catastrophizing, perceived stress and sleep quality were not associated to pain intensity in neither of group. Conclusions: In both TMD-CS and TMD-nCS patients, elevated anxiety levels were moderately and significantly associated with increased pain intensity. However, heightened levels of pain catastrophizing, perceived stress, and poor sleep quality were not significantly associated with increased pain intensity in either of the two analyzed groups.

• Journal of Oral Medicine and Pain
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• v.47 no.3
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• pp.117-125
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• 2022

Purpose: This study aimed to investigate whether and how the biopsychosocial features of myofascial pain (MFP) differ from those of local myalgia (LM) in temporomandibular disorder (TMD). Methods: Patients with TMD were retrospectively evaluated using the Diagnostic Criteria for TMD. All patients completed a series of self-administered questionnaires on pain severity and pain interference (Brief Pain Inventory, BPI), pain disability (Graded Chronic Pain Scale, GCPS), psychological distress (Symptom Check List-90-Revised, SCL-90R), pain cognition (Pain Catastrophizing Scale, PCS), and subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI). Among all the TMD diagnoses, muscle pain was classified into the MFP group and LM group. Results: This study included 917 patients with myalgia (MFP: 266, LM: 651). Significant differences were observed in the female ratio (78.9% for MFP, 60.9% for LM, p<0.001) and the mean pain duration (MFP: 25.3 months, LM: 15.8 months, p=0.001) between the two groups. Patients with MFP exhibited higher pain severity (p=0.003) and pain interference (p<0.001) of BPI than those with LM. Furthermore, the global scores of the PCS (p<0.001) and PSQI (p<0.001) were higher in the MFP group than in the LM group. The MFP group had higher global symptom index (p=0.017) and five subscales of the SCL-90R than the LM group. Compared with the LM group (33.4%), the greater proportion of high disability of GCPS was observed in the MFP group (44.9%) (p<0.001). Multiple regression analysis revealed that sex (p=0.002), pain duration (p=0.019), pain disability (p=0.010), and subjective sleep quality (p=0.008) significantly differed between the two groups. Conclusions: The findings of this study indicated that MFP presents a higher biopsychosocial burden than LM in TMD.

• Journal of Oral Medicine and Pain
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• v.35 no.2
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• pp.123-133
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• 2010

The purpose of this study is to investigate Tension-type headache associated with pericranial tenderness and Headache attributed to temporomandibular joint disorder among Characteristic pain index, Disability points, Chronic pain grade, Depression index, Nonspecific physical symptoms (pain items included), Nonspecific physical symptoms (pain items excluded), Jaw disability score using RDC/TMD Axis II. Eighty five patients who visited the Kyung Hee University Dental Hospital were diagnosed as Tension-type headache associated with pericranial tenderness(n=48) and Headache attributed to temporomandibular joint disorder(n=37) by the International Classification of Headache Disorders, 2nd Edition, and were administered the Korean versions of the RDC/TMD Axis II- Characteristic pain index, Disability points, Chronic pain grade, Depression index, Nonspecific physical symptoms (pain items included), Nonspecific physical symptoms (pain items excluded), Jaw disability score. Then it was analyzed statistically by SPSS(ver. 10.0). T-test, The Wilcoxon-signed rank test and Mann-Whitney U test (p<0.05) were used. There were no significant differences in Characteristic pain index, Disability points, Chronic pain grade, Depression index, Nonspecific physical symptoms (pain items included), Nonspecific physical symptoms (pain items excluded), Jaw disability score between two groups. Tension type headache associated with pericranial tenderness and Headache attributed to temporomandibular joint disorder showed similar Axis II feature. Tension-type headache associated with pericranial tenderness may be related to Headache attributed to temporomandibular joint disorder.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.5.1-5.5
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• 2016

Background: This study clinically evaluated the effect of botulinum toxin type A (BTX-A) in the temporomandibular disorder (TMD) treatment using Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Methods: A total of 21 TMD patients were recruited to be treated with BTX-A injections on the bilateral masseter and temporalis muscles and were followed up by an oral and maxillofacial surgeon highly experienced in the TMD treatment. For each patient, diagnostic data gathering were conducted according to the RDC/TMD. Characteristic pain intensity, disability points, chronic pain grade, depression index, and grade of nonspecific physical symptoms were evaluated. Wilcoxon signed-rank test was applied for statistical analysis. Results: The results showed that more than half of the participants (85.7 %) had parafunctional oral habits such as bruxism or clenching. In comparison between pre- and post-treatment results, graded pain score, characteristic pain intensity, disability points, chronic pain grade, and grade of nonspecific physical symptoms showed statistically significant differences after the BTX-A injection therapy (p < 0.05). Most patients experienced collective decrease in clinical manifestations of TMD including pain relief and improved masticatory functions after the treatment. Conclusions: Within the limitation of our study, BTX-A injections in masticatory musculatures of TMD patients could be considered as a useful option for controlling complex TMD and helping its associated symptoms.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.1
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• pp.27-33
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• 2018

Background: Temporomandibular disorder (TMD) represents a subgroup of painful orofacial disorders involving pain in the temporomandibular joint (TMJ) region, fatigue of the cranio-cervico-facial muscles (especially masticatory muscles), limitation of mandible movement, and the presence of a clicking sound in the TMJ. TMD is associated with multiple factors and systemic diseases. This study aimed to assess the prevalence of TMD in Nepalese subjects for the first time. Methods: A total of 500 medical and dental students (127 men and 373 women) participated in this study from May 2016 to September 2016. The Fonseca questionnaire was used as a tool to evaluate the prevalence of TMD, and Fonseca's Anamnestic Index (FAI) was used to classify the severity of TMD. Results: The majority of the participants with TMD had a history of head trauma, psychological stress, and dental treatment or dental problems. The prevalence of TMD in Nepalese students was mild to moderate. Conclusions: The prevalence of TMD in Nepalese subjects was mild to moderate. The majority of the study subjects had eyesight problems, history of head trauma, psychological stress, and drinking alcohol and had received dental treatments.

• Physical Therapy Korea
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• v.26 no.1
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• pp.28-36
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• 2019

Background: Temporomandibular disorder (TMD) is characterized by pain and limited range of motion in the jaw. TMD patients generally prefer to chew on the unaffected or less-affected side, and this tendency often results in asymmetries in masseter muscle thickness and range of mandibular motion. Objects: The purpose of this study was to compare the asymmetries in masseter muscle thickness and range of mandibular motion in subjects with and without temporomandibular disorders. Methods: Thirty-nine subjects were divided into two groups: A TMD group ($n_1=19$) and a control group ($n_2=20$). The jaw opening range and laterotrusion were measured using a digital vernier caliper. The masseter muscle thickness was examined in both the resting state and the maximal clenching state using ultrasonography. The absolute asymmetry indices calculated based on the laterotrusion and masseter muscle thickness of the respective right and left sides. A two-way ANOVA and a Mann-Whitney U test were used for statistical analysis. Results: No significant different was found in the masseter muscle thickness between the TMD and control group. A significant difference was found in the absolute asymmetry indices of mandibular laterotrusion between the TMD and control groups (p<.05). Furthermore, the ranges of jaw opening were significantly different between males and females (p<.05). The absolute asymmetry index values of masseter muscle thickness at rest and during maximal clenching were also significantly different between males and females (p<.05). Conclusion: These results demonstrated that the subjects with TMD had a larger degree of asymmetry in laterotrusion than those without TMD. Therefore, a physiotherapy program needs to be designed to restore normal laterotrusion capacities for TMD subjects. These results also showed that female subjects had greater absolute asymmetry indices in masseter muscle thickness than male subjects. Therefore, more training is needed to promote bilaterally balanced chewing among women.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.5
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• pp.232-236
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• 2018

Objectives: Hormonal changes during menopause alter a woman's susceptibility to some disorders. Information regarding the prevalence of temporomandibular disorder (TMD) in menopausal women is limited in the literature. In this study, the prevalence and severity of TMDs were compared between menopausal and non-menopausal women. Materials and Methods: The study included 140 women (69 premenopausal and 71 postmenopausal) 45 to 55 years of age that were examined in Shiraz Dental School, Shiraz in Iran. The Helkimo clinical dysfunction index (Di) was used to evaluate temporomandibular joint (TMJ) dysfunction. The data were analyzed using chi-square and Fisher's exact tests. Results: Occurrence of TMD was significantly higher in menopausal than non-menopausal women (P<0.001). All the TMD criteria based on Helkimo Di except range of mandibular movement were significantly more common in menopausal women. The range of mandibular movement was not significantly different between menopausal and non-menopausal women (P=0.178). Conclusion: The results from this study show that TMD can be considered more common and severe in menopausal than non-menopausal women. This finding indicates that, similar to other conditions in menopausal women such as arthritis and osteoporosis, TMD should be taken into consideration by dental and medical professionals.

• The Journal of Korean Academy of Prosthodontics
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• v.31 no.1
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• pp.63-76
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• 1993

The purpose of this study was to investigate the disclusion time and occlusal pattern during lateral movement in normal group and temporomandibular dysfunction (TMD) group. Twenty dental college students of Chosun University without the abnormal occlusion and temporomandibular dysfunction were selected as a normal group, and twenty slight temporomandibular dysfunction (TMD) group and the ten moderate temporomandibular dysfunction (TMD) group classified according to Helkimo's dysfunction index were selected. Occlusal pattern was classified as canine guided occlusion, group functioned occlusion and the other group during lateral movement and disclusion time in lateral movement was measured using T-Scan system. The result were as follows: 1. The disclusion time according to each group were $1.24{\pm}0.58$ sec in normal $1.60{\pm}0.79$ sec in slight TMD group and $2.29{\pm}0.80$ sec in moderate TMD group. There was statistically significant between normal group and moderate TMD group(P<0.01), slight TMD group and moderate TMD group(P<0.05). 2. The distribution of occlusal pattern in normal group was 62.5% (25 side) in canine guided occlusion, 27.5% (15 side) in group functioned occlusion. 3. The distribution of occlusal pattern in slight TMD group was 45% (18side) in canine guided occlusion, 35% (14 side) in group functioned occlusion and 20% (8side) in others and that in moderate TMD group was 15% (3 side) in canine guided occlusion, 35% (7 side) in group funcconed occlusion and 50% (10 side) in other 4. The disclusion time in normal group was $1.05{\pm}0.59$ sec at canine guided occlusion and $1.53{\pm}0.72$ sec at group functioned occlusion. 5. The disclusion time in slight TMD group was $1.23{\pm}0.75$ sec in canine guided occlusion, $1.50{\pm}0.88$ sec in group functioned occlusion, and $2.61{\pm}0.57$ sec, in the other. There was staistically significant between canine guided occlusion and other(P<0.001)and group functioned occlusion and the other (P<0.05). 6. The disclusion time in moderate TMD group was $1.28{\pm}0.84$ sec in canine guided occlusion, $1.75{\pm}0.58$ sec in group functioned occlusion, and $2.98{\pm}0.08$ sec in the other(P<0.01).