• 대한치과의사협회지
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• 제55권11호
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• pp.789-799
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• 2017

Ultrasound images are noninvasive, can be observed in real time, have no radiation exposure, do not cause pain, and are not restricted in use depending on the patient's prosthetic implant or medical condition. Since the use of ultrasound in the dental field was first applied for tooth preparation in 1957, the use of diagnostic ultrasound for the first time in 1963 has been reported. Currently, it is used in the diagnosis of soft tissue lesions such as malignant tumor or salivary gland disease, fine needle aspiration test, temporomandibular joint disease, lymph node metastasis, measurement of muscle thickness and inflammatory diseases, differentiation of periapical cyst and granulation tissue, measurement of periodontal tissue thickness. The ultrasound image can be visualized in real time. The clinician can explain the structure to the patient while consulting the patient and consult the patient. When injecting the drug into a specific site or aspirating a specific site or substance, So that it can be confirmed and practiced. Recently, ultrasonic equipment specialized in the dental field has been developed and marketed, and it is expected that the use of ultrasonic waves will become active in the dentistry. In the future, development of popular equipment with size and frequency suitable for dental diagnosis and various researches on maxillofacial ultrasonic anatomy. If clinical studies are continuously carried out to demonstrate efficacy, ultrasound is expected to aid in accurate diagnosis and treatment throughout the dentistry.

• Journal of Periodontal and Implant Science
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• 제47권4호
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• pp.211-218
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• 2017

Purpose: The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. Methods: Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. Results: The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. Conclusions: The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic long-term periodontitis without treatment should be urged to undergo a TMJ examination.

• Journal of Oral Medicine and Pain
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• 제41권4호
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• pp.161-168
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• 2016

Purpose: Patients who suffer from rheumatic arthritis, fibromyalgia, other various inflammatory diseases and musculoskeletal disorders, which are all similar to temporomandibular disorders (TMD), have been complaining about changes in the level and type of pain in response to changes in weather conditions for a long time. Through an investigation about pain perception in TMD patients in response to weather conditions, our primary objective was to develop base materials for future studies on change in pain in response to meteorological factors. Methods: Among patients who presented with TMD to Department of Oral Medicine, Pusan National University Dental Hospital from August to October 2016, one hundred consecutive TMD patients diagnosed with TMDs according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were recruited for the study and 28 patients were excluded according to exclusion criteria. Survey was done with the questionnaire and investigated whether there was any difference in incidence and level of pain in TMD patients between non-rainy and rainy days. Results: Among a total of 72 samples, 4 patients reported change in pain on rainy days rather than non-rainy days. Two patients from chronic group (joint and complex subgroup) reported increased pain on rainy days rather than non-rainy days but it was not statistically significant (p>0.05). One patient from chronic/muscle group reported the change in pain characteristics while pain intensity remained unchanged. One patient from acute/complex group reported decreased pain intensity. In comparison of the patients who reported increased pain on rainy days between acute and chronic groups, there were two reported cases and were both from chronic group only. There was a significantly higher chance of reporting increased pain on rainy days in chronic group than acute group (p<0.001). Conclusions: It is considered that TMD patients couldn't perceive the change in pain well in response to weather change on rainy days but some chronic patients could perceive the increase in pain in rainy days.

• Imaging Science in Dentistry
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• 제47권4호
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• pp.219-226
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• 2017

Purpose: This study investigated the relationship between pain and internal derangement in temporomandibular disorder(TMD) patients using magnetic resonance imaging (MRI). Materials and Methods: This study analyzed 356 TMD patients (712 temporomandibular joints [TMJs]). The inclusion criteria were the presence of spontaneous or provoked pain on one or both TMJs and having undergone MRI. The patients with provoked pain were divided into 3 groups: pain on palpation, pain on mouth opening, and pain on mastication. MRI was performed using a 1.5-T scanner. T1- and T2-weighted parasagittal and paracoronal images were obtained. According to the findings on the T1-weighted images, another 3 groups were created based on internal derangement: normal, disc displacement with reduction, and disc displacement without reduction. The MRI findings were independently interpreted by 2 experienced oral and maxillofacial radiologists at 2 different times. Statistical analysis was performed by the chi-square test using SPSS (version 12.0; SPSS Inc., Chicago, IL, USA). Results: Provoked pain on mouth opening was found to be correlated with internal derangement in TMD patients (P<.05). However, spontaneous pain and provoked pain on palpation or mastication were not associated with internal derangement(P>.05). Conclusion: These results suggest that internal derangement was a significant predictor of provoked pain on mouth opening.

• Journal of Oral Medicine and Pain
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• 제40권2호
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• pp.72-78
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• 2015

Purpose: The purpose of this research was twofold: to compare the short-term efficacy of once-off education versus repetitive education (RE) of patients suffering from temporomandibular disorders (TMDs) and to determine whether there was any correlation amongst patient demographics, recommendation adherence degree and pain levels. Methods: A total of 848 patients with TMDs were enrolled. The control group consisted of patients who received a standard conservative treatment (STD) over at least 6 visits with education provided only during the first visit. The experimental group consisted of patients who received STD but had also been given RE (STD+RE). The RE was delivered through a standardized self-assessment questionnaire (SAQ) that was completed by the patient during each visit. Pain, which included maximum comfortable opening (MCO) of the mouth and limitation of mouth opening (LOM), was compared between the two groups. Behavior pattern and reported pain level changes in the group who used the SAQ were also analyzed. Results: The LOM was significantly improved in all of the experimental group patients (especially in females under 30 years of age, p<0.05). The MCO was significantly higher in females (p=0.029). All of the patients displayed improvements in their habits following RE, which resulted in a strong correlation with pain reduction. Adhering to the recommendations regarding questions 14 and 15 of the SAQ appeared to have the greatest effect on pain reduction. Conclusions: These results clearly demonstrate that RE is more effective than once-off education for TMD patients who are female or under 30 years of age.

• Journal of Oral Medicine and Pain
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• 제47권3호
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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.

• PNF and Movement
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• 제20권3호
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• pp.451-459
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• 2022

Purpose: Temporomandibular disorder (TMD) is a common musculoskeletal problem that causes pain in and disability of masticatory muscles, the temporo-mandibular joint (TMJ), and related structures. The purpose of this study was to compare pressure pain thresholds (PPTs) of masticatory muscles, cervical ranges of motion (ROM), and pelvic mobility during gait of subjects with or without TMD. Methods: In this study, pain thresholds and changes in the mobility of the cervical vertebrae and pelvis were measured in 25 patients with TMD and 25 healthy controls. Using a pressure algometer, the pressure pain thresholds (PPTs) of the masseter and temporalis muscles were measured in both groups. A gyroscope sensor with a mobile application was used to determine cervical ROM in the frontal and sagittal planes. A 3D-motion analysis system was used to evaluate pelvic mobility in the sagittal, frontal, and transverse planes during gait. Results: The TMD group showed significantly decreased PPTs of masseter and temporalis muscles compared with the control group (p < 0.05). Cervical ROM in flexion, extension, and lateral bending were significantly decreased in the TMD group compared with the control group (p < 0.05). In addition, antero-posterior pelvic tilt was significantly decreased in the TMD group (p < 0.05). Conclusion: The results of the current study suggest that there are close anatomical and functional relationships between TMD and muscle chains related to the cervical spine and pelvis. Therefore, more comprehensive body posture assessments, especially of painful areas, should be undertaken when studying TMD patients.

• 한방재활의학과학회지
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• 제27권4호
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• pp.67-74
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• 2017

Objectives This study is aimed to identify and evaluate the already developed clinical practice guidelines (CPGs) of temporomandibular disorders (TMD) and contribute to making decisions in developing Korean medicine CPG of TMD. Methods We searched electronic database and selected CPGs of TMD according to the inclusion and exclusion criteria. Then, we made appraisal of selected CPGs by using AGREE II (Appraisal of Guidelines for Research & Evaluation II). Results Four CPGs are included and appraised with AGREE II. Among 6 domains of AGREE II, all CPGs failed to score over 60% in four domains. Only one CPG mentioned acupuncture as an adjunctive treatment for myofascial TMD. Conclusions It is difficult to indicate that included CPGs are with sufficient quality to recommend and it appears not to be appropriate to apply these already developed CPGs in Korean medicine clinical fields. Therefore, developing a new Korean medicine clinical practice guideline of TMD is required.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.27.1-27.8
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• 2018

Purpose: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. Materials and methods: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors' department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. Results: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. Conclusions: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.

• Journal of Oral Medicine and Pain
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• 제31권1호
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• pp.101-111
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• 2006

측두하악관절장애에 관한 역학연구는 주로 1970년대 초 스칸디나비아국가에서 국민을 대상으로 무작위 추출법에 의한 악관절 및 저작계기능에 관한 역학조사로 시작되었으며 국내에서도 1970년대 이후 측두하악관절장애의 유병률에 대해 많은 역학연구가 보고되었다. 하지만 성, 병력, 주소, 진단에 따른 각각의 증상과 징후들을 평가한 연구는 외국에 비해서 많이 부족한 실정이다. 측두하악관절장애에 대한 증상과 진단에 관한 총괄적 연구조사는 오래전에 이루어진 것이 대부분이기 때문에 본 연구를 통해서 측두하악관절장애를 가진 환자들의 성, 병력, 주소, 진단에 따른 증상들을 총괄적으로 조사하여 향후 점증하는 측두하악관절장애환자의 진단과 치료에 도움이 되는 기초자료를 확보하고자 하였다. 본 연구결과를 보면 우선 연령의 경우 전체 내원 환자 6500명의 평균나이는 34.06세로 남자는 33.15세, 여자는 34.62세였으며 진단그룹별로 연령차이가 있었다. 의뢰 환자는 대체로 치과의사가 의뢰한 환자가 많았으며(80.07%), 의뢰한 환자 진단군은 관절성장애, 근육성장애, 연조직질환 순이었다. 전체 내원 환자 중 63%가 안면통증으로 내원하였으며, 발생부위에 대한 비교에서 좌우 유의한 차이를 볼 수 없었다. 또한 통증 발생은 6개월 미만에서는 주로 남성이, 6개월 이상인 경우는 여성의 비율이 상대적으로 높음을 알 수 있었다. 관절잡음의 경우 병력 환자는 3445명(53.15%)였으며, 발병시기에는 성차가 없었다. 관절잡음의 발생부위는 좌우 양측간에 차이가 없었으며 주로 clicking sound가 많음을 알 수 있었다. 이갈이는 주로 남자에서, 이악물기는 여자에서 나타났었다.