• Journal of Oral Medicine and Pain
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• 제40권2호
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• pp.47-54
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• 2015

Purpose: Besides depression and anxiety, recently pain catastrophizing has been emphasized for an important psychological factor explaining pain response in various pain conditions including temporomandibular disorders (TMDs). The aims of this study were to evaluate pain catastrophizing of TMD patients and to investigate how the level of pain catastrophizing related with clinical variables and psychometric morbidity. Methods: Inclusion criterion was all new TMD patients ${\geq}18$ years old attending the Department of Orofacial Pain and Oral Medicine of Dankook University Dental Hospital (Cheonan, Korea) over three-month period in 2014, who completed questionnaires. The questionnaires included the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Symptom Check List- 90-Revised (SCL-90-R). All of them were examined clinically and diagnosed. Results: One hundred fifty five patients diagnosed as TMDs were participated in this study (mean age of $38.7{\pm}15.2$ years, male:female=1:2.5). Mean PCS score of the patients was 17.3 with standard deviation of 12.6. By the median of the PCS score (i.e., 15), the subjects were categorized into the high (${\geq}15$) and low catastrophizers (<15). Increased pain severity and interference and increased score of psychological features of SCL-90-R were found in the TMD patients with higher level of catastrophizing (p<0.001) and there was weak to moderate correlation between those factors (p<0.05). Difference in catastrophizing level was not found for other variables such as age, gender, duration of pain, education level and types of TMDs. Conclusions: Conclusively, pain catastrophizing of TMD patients relates positively to pain severity and pain interference. In addition to depression and anxiety, pain catastrophizing is positively correlated with variable other psychological morbidity such as somatization, obsessive- compulsive, interpersonal sensitivity, paranoid ideation and psychoticism. Types of TMD diagnosis do not seem to affect catastrophizing level. The results of this study suggest that pain catastrophizing should be emphasized and assessed in the TMD patients.

• Journal of Oral Medicine and Pain
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• 제43권2호
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• pp.34-40
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• 2018

Purpose: The aim of this study was to translate the original English version of tampa scale for kinesiophobia for temporomandibular disorders (TSK-TMDs) for cultural equivalency into Korean language and to evaluate the reliability of the Korean version of the TSK-TMD among symptom free subjects. Methods: The original version of TSK-TMD was translated and cross-culturally adapted following international guidelines. A total 90 subjects (50 women, 40 men) were participated to fill out the questionnaire. The internal consistency and test-retest reliability with a one- or two-week time interval were evaluated. Results: The internal consistency of TSK-TMD of the original and the modified 12-item TSK-TMD were 0.866, and 0.858, respectively using the Cronbach's alpha coefficient. And the internal consistency of activity avoidance (AA) and somatic focus (SF) subscale were 0.838 and 0.807 assessed with Cronbach's alpha indicating excellent reliability. Test-retest reliability of the original TSK-TMD measured by the intra-class correlation coefficient (ICC) was 0.764, and coefficients value of the 12-question TSK-TMD was 0.752. Test-retest reliability of AA subscale was 0.722 and SF subscale was 0.677 measured by ICC. Conclusions: The Korean version of the TSK-TMD questionnaire was found to be a reliable instrument and successfully translated to Korean language. There are no significant differences between overall and modified version of TSK-TMD. It can be used as a valuable instrument for the analyses of the psychosocial aspects of the TMD patients in Korea.

• Journal of Oral Medicine and Pain
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• 제43권2호
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• pp.41-51
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• 2018

Purpose: The aim of this study was to evaluate the possibility of utilizing blood tests for the diagnosis of temporomandibular disorders (TMDs) by investigating the hematologic characteristics of TMD patients according to the main source and level of TMD pain and analyzing their interrelationship. Methods: Clinical examination following the research diagnostic criteria for TMD and hematological and psychological evaluations were conducted in 357 TMD patients. Patients were divided into groups according to the main source of pain (myogenous, arthrogenous, and combined pain) and the degree of pain according to the graded chronic pain scale (GCPS). Hematological differences among the groups were statistically analyzed. Results: The C-reactive protein (CRP) level was significantly higher in the arthrogenous pain group compared to the combined pain group (p=0.032). There was no significant difference according to the GCPS classification. There were significant correlations between some of the TMD pain indices and the hematologic indices, and also between the psychological indices and the hematologic indices. Conclusions: This study suggests the possibility of applying blood tests to the diagnosis, treatment and prevention of TMD. Further research should be conducted focusing on the role of CRP in TMD pain with more refined methodology and a longitudinal study design.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권1호
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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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• 제47권4호
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• pp.198-205
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• 2022

Purpose: The first-line treatment of temporomandibular joint disorders (TMDs) should include self-management and education. Self-management techniques include moist heat application, stretching, diet control, and mandibular rest position adjustment. Although the effectiveness of video educational resources has been studied in multiple sectors, their application in TMD management has not yet been explored. This study seeks to assess how effective media education was at motivating TMD patients to self-management and improve symptoms. Methods: Data were obtained from the hospital records of TMD patients who visited the Department of Oral Medicine, Yonsei University Dental Hospital, between May 2020 and December 2021. First, without any differences between groups, a significance analysis was conducted between the degree of self-management and symptom improvement over time. At the second visit, one group received media education (n=31) linked to TMD management, while the other received written-oriented education (n=45). At the third visit, the number of precautions taken by the patients was determined and contrasted to that recorded in the previous visit between the groups. Generalized estimated equation multivariate models were applied for statistical analysis. Results: In the media education group, the frequency of stretching and the number of patients on pain-free diets increased substantially. Taking precautions improved daily pain intensity, maximum mouth opening, and pain intensity during the maximum unassisted opening. Conclusions: Media education could be beneficial for TMD patients because it allows them to take self-management precautions. The symptoms of the media education group improved, with no considerable distinction between both groups.

• The Korean Journal of Pain
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• 제37권2호
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• pp.164-177
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• 2024

Background: Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on cranio-cervico-mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Methods: Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Results: Jaw and neck pain negatively affected CVA (R² = 0.130), TMJPS (R² = 0.286), DNFE (R² = 0.355), TMJ depressor (R² = 0.145), cervical flexor (R² = 0.144), and extensor (R² = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R² = 0.116) and extension (R² = 0.146), as well as total sway degree (R² = 0.128) and MFIQ (R² = 0.230). Conclusions: Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs.

• Journal of Oral Medicine and Pain
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• 제39권1호
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• pp.26-28
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• 2014

Nasopharyngeal cancer is malignant tumor of nasopharyngeal area that is characterized of lymphadenopathy, pain, otitis media, hearing loss and cranial nerve palsy and may present symptoms similar to temporomandibular disorder such as facial pain and trismus. In this case, the patient with symptoms similar to temporomandibular disorder after surgery for otitis media presented with facial paresthesia and masticatory muscle weakness. Examinaion of trigemimal nerve was shown sensory and motor abnormaility. The patient was referred to a neurologist. Nasopharyngeal cancer was suspected on computed tomography and magnetic resonance imaging and was confirmed by biopsy. If the patient presenting with paresthesia and muscle weakness the cranial nerve examination should be performed regardless of typical temporomandibular disorder symptom. The neurologic symptom can be caused by neoplasm such as brain tumor and nasopharyngeal cancer. Nasopharyngeal cancer on rosenmuller fossa can develop otitis media. Therefore, the patient with otitis media history should be consulted to otorhinolaryngologist to examin the nasopharyngeal area.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권6호
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• pp.297-303
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• 2013

Alloplastic total replacement of the temporomandibular joint (TMJ) was developed in recent decades. In some conditions, previous studies suggested the rationale behind alloplastic TMJ replacement rather than reconstruction with autogenous grafts. Currently, three prosthetic products are available and approved by the US Food and Drug Administration. Among these products, customized prostheses are manufactured, via computer aided design/computer aided manufacturing (CAD/CAM) system for customized design; stock-type prostheses are provided in various sizes and shapes. In this report, two patients (a 50-year-old female who had undergone condylectomy for the treatment of osteochondroma extending to the cranial base on the left condyle, and a 21-year-old male diagnosed with left temporomandibular ankylosis) were treated using the alloplastic total replacement of TMJ using stock prosthesis. The follow-up results of a favorable one-year, short-term therapeutic outcome were obtained for the alloplastic total TMJ replacement using a stock-type prosthesis.

• Journal of Oral Medicine and Pain
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• 제44권3호
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• pp.127-132
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• 2019

Septic arthritis of the temporomandibular joint (TMJ) is an uncommon disease caused by microbial pathogens through hematogenous infection, local spread, or iatrogenic infection. As the symptoms have an insidious onset, the early stage of septic arthritis is often confused with other diseases. A 49-year-old man was referred for increasing preauricular pain, swelling, and restricted mouth opening. He had been initially diagnosed as having a conventional temporomandibular joint disorder and trigeminal neuralgia and had been treated for the same. Imaging studies including panoramic view, lateral tomography, computed tomography with contrast enhancement, and magnetic resonance imaging were performed. Erosive bone change with displacement of the involved condyle, diffuse swelling of adjacent soft tissue, and fluid collection in the joint space were noted. Needle aspiration of the joint space and bacterial culture confirmed the diagnosis of septic arthritis of the TMJ and he was treated with antibiotic therapy and surgical drainage. Clinicians should always consider the diagnosis of septic arthritis of the TMJ in patients with preauricular pain or swelling.

• 대한치과의사협회지
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• 제57권4호
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• pp.204-212
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• 2019

Introduction : Patients with temporomandibular disorder may have various ear-related symptoms. If an excessive load is applied to the ear area due to the skeletal shape of the mandibular condyle or malposition of the disc, an auditory problems may occur. Case report : The patient was referred to our clinic due to the suspicion of temporomandibular disorder from the local otorhinolaryngology clinic. A few days ago, his right ear could not be heard. MRI showed that the left TMJ disc was anterior displacement with reduction, the right TMJ disc was anteromedial displacement without reduction. Also Right mandibular condyle showed sclerotic bone change, subchondral cyst and was compressing the frontal wall of the ear on MRI view. Right TMJ arthroplasty was done under the diagnosis of right TMJ osteoarthritis and osteochondroma. Postoperative intermaxillary fixation was done with SAS screw and elastics for 2 weeks. One month after the operation, hearing and TMJ discomfort were recovered without any complications. Conclusions As seen in this case, hearing loss due to benign tumor-like lesions of the temporomandibular joint should be treated surgically to restore the TMJ function and hearing.