• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.2
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• pp.102-108
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• 2016

Headache disorders, one of most common disease in general population, have been developed according to many versions of international classifications. The primary headaches are those in which no consistently identified organic cause can be determined. It is divided into the following categories: (1) migraine, (2) tension-type headache, (3) cluster headache and other trigeminal autonomic cephalalgias, (4) other primary headaches. This review described a diagnosis of primary headache disorders based on International Classification of Headache Disorders (ICHD)-3 beta criteria.

• Journal of Oral Medicine and Pain
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• v.40 no.2
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• pp.55-62
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• 2015

Purpose: The aims of this study were to evaluate the differences in subjective symptoms, clinical characteristics, distribution according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) subgroup, psychological profile of TMD patients, and to identify the prevalence and trend according to age. Methods: A total of 1,052 patients (261 men and 791 women; mean age, $34.40{\pm}15.73$ years) who visited the Orofacial Pain Clinic of the Department of Oral Medicine, Seoul National University Dental Hospital complaining of TMD symptoms of were evaluated. All patients were questioned for medical history, clinical symptoms and contributing factors. Clinical examination and patient grouping based on RDC/TMD was conducted. Radiographies were taken. The Korean version of RDC/TMD axis II and Symptom Checklist-90-Revision (SCL-90-R) were administered to evaluate pain-related disability level and psychological status of the patients. Results: Prevalence peaked in the 20-year-old age group. There were more women than men in all groups. The highest T-score among SCL-90-R dimensions was somatization in each group, except for teenagers who showed the highest T-score in interpersonal sensitivity. The 30-year-old age group showed the highest distribution of high disability based on the graded chronic pain scale. Age was positively associated with pain intensity (r=0.100), number of positive muscles on palpation (r=0.137) and negatively associated with maximum mouth opening (r=-0.168). Conclusions: Subjective symptoms and clinical characteristics of TMD patients show distinct tendencies according to different age groups. Treatment should be customized and personalized according to age for efficient symptom resolution and patient satisfaction.

• Journal of Dental Rehabilitation and Applied Science
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• v.37 no.4
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• pp.225-231
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• 2021

There are many studies on the indications and efficacy of splint therapy commonly used in patients with temporomandibular disorders (TMD). However, there have been no studies on the splint weaning in terms of the splint use tapering period in relation to symptom improvement of TMD. This retrospective study aims to analyze a proper splint weaning method in patients with TMD based on symptom improvement. Materials and Methods: The authors examined 130 TMD patients with TMJ disorders, masticatory muscle disorders, and clenching/bruxism who had received splint therapy (occlusion stabilization splint, anterior positioning splint) of patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital from 2015 to 2020. They were evaluated according to the method to wean splints. Results: The mean splint therapy period was 29.0 months, during which patients wore splints 7 days a week for 8.4 months, 3 - 4 days a week for 9.5 months, and finally 1 - 2 days a week for 11.1 months (a total of 29.0 months, about 2.5 years). Conclusion: It seems that TMD symptoms can be alleviated and side effects such as occlusal change can be minimized if patients wear a splint 7 days a week for the first 6 months, followed by 3 - 4 days a week for the next 6 to 18 months, and finally 1 - 2 days a week after 18 months.

• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.87-95
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• 2013

Osteoarthritis (OA) of the temporomandibular joint (TMJ) is a severe form of temporomandibular disorders (TMDs), presenting gradual breakdown of articular cartilage and subchondral bone by the functional load sustained to exceed the physiologic tolerance of the joint. In such a joint loaded, offensive bioactive materials such as matrix degrading proteins, cytokines, and free radicals increase in concentration to shift the tissue response in the joint to degeneration from regeneration or remodeling. Recently, it has been issued that obesity can play an offensive role in pathogenesis of OA in a metabolic way. Adipokines released by adipose cells are present at higher concentration in the arthritic joint and joints of obese individuals. However, because of conflicting data reported, further scientific study should be performed to elucidate the practical role of adipokines in pathogenesis of TMJ OA. As far as the clinical signs and symptoms of TMJ OA are not much different from those of other forms of TMD and any definitive treatment modality to control directly the bone resorptive activity is not available yet, the treatment of TMJ OA should be directed to reduce the physical load and enhance the physiologic tolerance of the joint by means of conservative treatment such as physical therapy, medication, and occlusal splint therapy for sufficient period and, if needed after that, supplementary surgical procedure such as intra-articular injection, arthrocenthesis, and arthroscopic surgery that have turned out to be effective to control OA signs and symtpoms. Enthusiastic reassurance and motivation for patients to control behaviors for themselves to reduce unnecessary functional load in daily life is very important for the joint to reach to more favorable orthopedic stability of the TMJ more quickly, guaranteeing more successful management TMJ OA.

• Journal of Oral Medicine and Pain
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• v.33 no.4
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• pp.387-394
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• 2008

Purpose : The purpose of this study was to verify the usefulness and feasibility of ultrasonographic imaging for the detection of the disorders of the surrounding supporting structure such as articular capsule, retrodiscal tissue and related ligaments, osteoarthritic evidence and associated disc displacement at the temporomandibular joint(TMJ) Materials and Methods : 20 patients(40 joints) with periodic lock and crepitations were investigated prospectively using 12 MHz array transducer. Ultrasonographic Imagings were assessed for osteoarthritic surface changes of condyle, extent of disc displacement and disorders of surrounding structures. Ultrasonographic images were compared with clinical investigations, conventional radiography and Dental Computed Tomographic scans. Results : In clinical and conventional radiography, osteoarthritic changes were diagnosed in 8 joints. Ultrasonographically 7 of the 8 osteoarthritic changes were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 87.5%, 62.5%, and 67.5% respectively. About the detection of disc displacement, disc displacement were diagnosed in 21 joints clinically. Ultrasonographically 19 of the 21 disc displacements were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 95%, 90%, and 92.5% respectively. when the disorders of supportive structure were figured out, the disorders of supportive structure were diagnosed in 18 joints clinically. Ultrasonographically 1 of the 18 the disorders of supportive structure were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 5.5%, 4.5%, and 55% respectively. Conclusion : Ultrasonography is an relatively reliable diagnostic tool for the detection of disc displacement and some of osteoarthritic changes. But it's not an insufficient imaging technique for the detection of the disorders of the surrounding structure.

• 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 Oral Medicine and Pain
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• v.42 no.2
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• pp.29-34
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• 2017

Purpose: To evaluate aggravating factors of intermittent locking among temporomandibular joint using magnetic resonance imaging (MRI) and diagnostic criteria for temporomandibular disorder (DC/TMD) diagnosis. Methods: A retrospective analysis was conducted of 35 patients with intermittent locking history but normal intra-articular findings between September 2012 and June 2015 in Kyung Hee University Dental Hospital. A standardized DC/TMD assessment was performed on subjects with MRI findings. Clinical findings were assessed on the basis of maximum mouth opening (active & passive), self-reported habits, patients' age, gender, systemic diseases at the initial visit. First, chi square test was used to examine differences with variables and then risk factors for intermittent locking were assessed using multivariate logistic regression. Results: Self-reported bruxism was strongly associated with intermittent locking history. Conclusions: The new DC/TMD protocol is intended for use within any clinical setting and supports the full range of diagnostic activities from screening to definitive evaluation and diagnosis. Self-reported sleep bruxism has been associated with a higher likelihood of intermittent locking. Comorbidity is therefore a factor that must be assessed. It is necessary to consider the amount of contact of the teeth and the duration.

• The Journal of Korean Academy of Prosthodontics
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• v.54 no.4
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• pp.431-437
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• 2016

In cases of extensive prosthetic restoration, correction of occlusal contact is often needed, as it is the essential component for a successful restoration. If occlusal contact is given incorrectly, various symptoms of occlusal trauma can occur of which temporomandibular joint disorder (TMD) is one of them. As one of the common symptoms of TMD, patients may suffer with masticatory muscle disorder and temporomandibular joint pain. This case presents satisfactory results for the improvement of masticatory muscles and temporomandibular joint pain of a TMD patient, caused by incorrect occlusal contact of the restoration, by replacing the prosthesis after occlusion correction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.3
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• pp.139-144
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• 2012

This study was performed in order to evaluate the occurrence of temporomandibular joint disorder after surgical correction of skeletal class II malocclusion. Materials and Methods: This study included 21 patients who underwent orthognathic surgery for the correction of dentofacial deformities by a single surgeon at Mokdong Hospital, Ewha Womans University from 2000 to 2010. They underwent bilateral sagittal split ramus osteotomy for the treatment of undesirable mandibular advancement. The temporomandibular disorder (TMD) symptoms prior to surgery were recorded and the radiographic evaluation (panorama, bone scan, and magnetic resonance imaging [MRI]) of the post-surgery temporomandibular joint (TMJ) were assessed in order to evaluate condylar resorption, remodeling and disc displacement. The minimum follow-up period, including orthodontic treatment, was 12 months. Orthognathic procedures included 1-jaw surgery (n=8 patients) and 2-jaw surgery (n=13 patients). The monocortical plate was used for bilateral sagittal split ramus osteotomy fixation. Results: Among class II malocclusion patients with TMD symptom, clicking improved in 29.1%, and maximum mouth opening increased from $34.5{\pm}2.1$ mm to $37.2{\pm}3.5$ mm. The differences were not statistically significant, however. Radiographic changes in bone scan improved slightly based on the report by radiologist but not in TMJ dynamic MRI. Conclusion: No particular improvements were found in patients with joint sound only. Patients with limitation of mouth opening showed an increase in the degree of opening, but the difference was not statistically significant (P>0.05).

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.143-147
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• 2013

Mouth opening limitation is generally caused by masticatory muscle or temporomandibular joint pain, disc dislocation without reduction, adhesion or ankylosis of the temporomandibular joint, and muscle contracture. But otorhinolaryngologic disease, neurologic and vascular disease, tumor, inflammation and infection may cause pain and mouth opening limitation which mimics temporomandibular disorders. Re-evaluation for possibilities of inflammation, infection and tumor should be in cases that do not show symptom improvement or appear with continuous aggravation despite of proper treatment. In this case, we report of medial pterygoid muscle pain and mouth opening limitation caused by periapical abscess of third molar spread to the pterygomandibular space.