• Journal of Oral Medicine and Pain
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• 제41권4호
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• pp.169-179
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• 2016

Purpose: This study is designed to analyse etiology and bone pattern at the first visit using cone-beam computed tomography (CBCT) and to evaluate the treatment outcome of conservative treatment in temporomandibular disorder (TMD) patients with rheumatoid arthritis (RA). Methods: One hundred condyles in 50 subjects with RA were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Dental Hospital, diagnosed as TMD. Condylar bone changes were classified by normal, erosive bony change, proliferative bony change and combined group (erosive bony change+proliferative bony change). They were treated conservatively with physical therapy, medication, behavioral therapy and/or occlusal stabilizing splint therapy. After 3 months on average, patients were re-evaluated with regards to subjective symptoms and the clinical findings were investigated. Results: TMD patients with RA have behavioral contributing factors such as parafunctional habit. The results that analyse bone pattern at the first visit using CBCT proliferative bony changes group (32.6%) were more common than erosive bony changes group (15.2%). In comparison between unilateral and bilateral bony change in temporomandibular joint, the ratio showed no significant differences. After 3 months of conservative treatments, pain, noise, limitation of motion (LOM) were markedly improved regardless of occlusal splint therapy. However only LOM was significantly improved through occlusal splint therapy during 3 months. Conclusions: TMD patients with RA had similar behavioral contributing factors and characteristics of CBCT images shown in general TMD patients and also similar response to conservative treatment so it is difficult to differentiate. Therefore when TMD patients show symptoms corresponding to clinical diagnostic criteria of RA at the first visit, serological testing should be conducted and through this, early diagnosis and treatment of RA should be initiated.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.520-527
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• 2010

Introduction: This study examined the treatment patterns of temporomandibular disorders (TMD) including conservative and surgical procedures. Materials and Methods: Patients with TMD who visited Gangnam Severance Hospital from June 2007 to May 2008 were enrolled in this study. All patients were examined from the orthopantomogram, temporomandibular joint (TMJ) tomography, and a clinical examination. The patients who required a further evaluation were examined by magnetic resonance imaging and/or computed tomography. The treatment patterns were divided into counseling, medication, splint therapy, botulinum toxin injection (BTI) and surgical treatment. Results: Among the 2,464 patients, the average age was 31.8 years (ranging from 6 to 93); 764 (31.0%) were male and 1,700 (69.0%) were female. 2,355 (95.6%) patients were treated with conservative therapy; 1,460 (62.0%) patients were treated with medication, 931 (39.5%) patients were treated with splint, and 46 (2.0%) were treated with BTI. There were 109 (4.4%) patients treated surgically. Eight (0.3%) patients were treated with total temporomandibular joint replacement surgery. Conclusion: Almost all patients with TMD were treated using conservative methods. Those patients who received surgical treatment because of an ineffective response to conservative treatment had definite problems with the internal derangement and/or osteoarthritis or had severe clinical symptoms.

• 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.

• 한국전문물리치료학회지
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• 제15권1호
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• pp.61-68
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• 2008

The aim of the study was to evaluate the effect of a disease-specific exercise (DSE) on temporomandibular joint (TMJ) function and neck mobility in TMJ dysfunction associated with ankylosing spondylitis (AS). Ten AS patients (seven males and three females) with TMJ dysfunction were recruited for this study. The DSE included exercises to correct head and neck posture and to improve the flexibility of the neck and TMJs. The patients attended treatment three times a week for 4 weeks, averaging 1 hour each session. Assessments were performed pretreatment, posttreatment, and 6 weeks after the completion of treatment. General physical status was assessed by four clinical measures (tragus-to-wall distance, modified Schober test, lumbar side flexion, and intermalleolar distance), the Bath ankylosing spondylitis function index (BASFI), and the Bath ankylosing spondylitis disease activity index. The main outcome measures included TMJ function (craniomandibular index (CMI)), and neck mobility (flexion, extension, rotation, and lateral rotation). None of the measures of general physical status, with the exception of BASFI, were significant1y different between the pretreatment, posttreatment, and 6-week follow-up (p>.05). However, CMI and all neck movements, except for extension, significant1y improved after the treatment (p<.05). These improvements were maintained during the follow-up period. The DSE used in the present study seems to be a clinical1y useful method for managing patients with symptoms from the stomatognathic system in AS. Further studies with more subjects and longer treatment times, including the follow-up period, will be conducted to validate these findings.

• Journal of Oral Medicine and Pain
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• 제38권1호
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• pp.87-95
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• 2013

측두하악관절 골관절염은 측두하악장애의 한 형태로 관절조직의 생리적 내성을 초과하는 기능적 부하가 지속적으로 관절에 가해졌을 때 관절연골 및 연골하 골조직의 점진적 파괴와 이차적 염증을 특징으로 하는 질환이다. 관절면에 가해지는 물리적 하중은 관절내에서 기질파괴 단백효소나 염증성 cytokine, 유리기의 활성을 증가시키고, 그에 따라 골조직의 퇴행과 재형성 사이의 균형을 깨뜨려 골조직의 흡수를 야기한다. 최근에는 물리적 하중 이 외에 비만세포에서 유래하는 adipokine이 골흡수를 증가시킨다는 보고들이 있으나 측두하악관절에 적용하기에는 아직 추가적인 연구가 필요하므로 현재로서 골관절염의 치료는 관절의 기능적 부하를 줄이고 환자의 생리적 내성을 증가시키는 방향으로 이루어져야 한다. 임상증상은 충분한 기간 정확한 술식대로 시행한 물리치료, 약물치료, 교합안정 장치치료 등의 보존적 처치와 관절강내 주사요법이나 관절세척술 및 관절경 수술과 같은 추가적인 외과적 처치에 의해 성공적으로 조절될 수 있으나, 임상증상의 개선이 골파괴의 중지와 재형성을 담보하는 것은 아니므로 임상증상의 개선 이 후에도 지속적인 골변화의 추적관찰이 필요하다. 또한, 골변화 활성 자체를 직접적으로 조절할 수 있는 활용 가능한 치료법이 없는 한, 지속적인 동기유발과 행동조절을 통해 관절에 가해지는 기능적 부하를 환자 스스로 조절할 수 있도록 끊임없이 교육하는 것이 골변화를 겪는 측두하악관절로 하여금 보다 이른 시기에 보다 유리한 정형적 안정에 도달하게 함으로써 골관절염을 보다 성공적으로 조절할 수 있는 길이라고 할 수 있다.

• 한국치위생학회지
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• 제18권5호
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• pp.797-806
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• 2018

Objectives: The purpose of this study was to analyze Influence of stress on oral health and quality of life. Methods: The participants were 172 students from 4 universities located in DaeJeon, South Korea. A questionnaire was administered, assessing the impacts of the general characteristics of the participants, temporomandibular joint (TMJ) symptoms, xerostomia, and halitosis on stress. And oral impacts on daily performance were also investigated. Data were analyzed using the Statistical Package for the Social Sciences 18.0. Results: The level of stress was higher in female, and the causes of stress was reported scholastic achievement, relations with professors, get a job. The students who were higher stress were more conscious of TMJ symptoms, xerostomia and halitosis(p<0.05). Stress was significantly positively correlated with TMJ symptoms (r=0.376, p<0.001), dry mouth (r=0.360, p<0.001), and bad breath (r=0.343, p<0.001). Oral Impacts on Daily Performance (OIDP) scores were significantly positively correlated with dry mouth, bad breath, TMJ symptoms, and stress. Regression analysis showed that 54.5% of the independent variables were related to OIDP scores. Stress and TMJ symptoms exerted a significant effect on OIDP scores. Conclusions: Stress among university students affects oral health and quality of life. Stress coping mechanisms and oral health care education programs should be developed and applied at universities.

• 대한치과의사협회지
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• 제55권10호
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• pp.706-714
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• 2017

Background Synocial chondromatosis(SC), a proliferative disorder of the synovial membrane. The etiology or cause of SC remains unclear. SC usually occurs in large articular joints such as knee, hip, elbow, and ankle. SC of the TMJ is very rare. It is a benign disease that mainly affects unilateral side. It can form cartilagenous and calcified loose bodies of various sizes and cause abnormal function of TMJ. Case Report In this paper, we report two cases of SC in the upper joint space of the left TMJ. One complained that "Sometimes the left jaw joint feels disoriented" and the other had no symptoms. CT scan and MRI showed left TMJ space widening, multiple tiny calcified mass. After clinical and radiographic analysis, we performed surgical removal of the lesion under genereal anesthesia. In the histologic examination, synovial chondromatosis was diagnosed in both patients. Conclusions We report two cases of synovial chondromatosis in the upper joint space of the left TMJ. We performed surgical removal of the lesion. The two patients showed good prognosis without recurrence or pain up to date.

• Journal of Acupuncture Research
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• 제35권3호
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• pp.129-137
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• 2018

Background: The purpose of this study was to determine the effect of Postural Yinyang correction of the temporomandibular joint (functional cerebrospinal therapy) on temporomandibular disorder. Methods: Medical records of 21 outpatients were reviewed who were diagnosed with temporomandibular joint disorder, unspecified (K0769) and treated at the Department of Acupuncture & Moxibustion, Dong-Eui University Korean Medicine Hospital from May $1^{st}$, 2017 to April $30^{th}$, 2018. Patients received more than 10 treatments of upper cervical manipulation and performed self-exercise therapy more than 3 times a day and wore an accurate balancing appliance in the oral cavity for more than 8 hours per day. To estimate the efficacy, visual analogue scale (VAS), numerical rating scale (NRS), maximum mouth opening (MMO), symptom intensity scale (SIS), max SIS (MSIS), symptom frequency scale (SFS), mandibular function impairment questionnaire (MFIQ) and 5-point Likert scale were used. Results: NRS and MSIS were significantly improved during each period. VAS, MMO, SIS, and SFS were significantly improved during each period, except the period from the $8^{th}$ to $10^{th}$ visit. MFIQ score was significantly improved during the period from the $1^{st}$ to $10^{th}$ visit. In the 5-point Likert scale, the results showed a high patient satisfaction with the treatment. Conclusion: These results showed that functional cerebrospinal therapy using an accurate balancing appliance, may be useful for reducing the symptoms of temporomandibular disorder.

• Journal of Oral Medicine and Pain
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• 제35권2호
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• pp.123-133
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• 2010

6개월간 경희대학교 치과병원 구강내과에 내원한 환자 중 두개주변압통과 관련된 긴장성 두통으로 진단된 총 48명(남자 11명, 여자 37명)과 측두하악장애에 기인한 두통으로 진단된 총 37명(남자 4명, 여자 33명)을 대상으로 하여 특징적 통증강도, 기능 제한 점수, 만성통증척도, 우울증 정도, 비특이적 신체 증상 등급, 하악기능과 관련된 기능제한에 대한 설문지(RDC/TMD Axis II한글판)를 통한 조사 후 다음과 같은 성적을 얻었다. 1. 특징적 통증 강도는 두개주변압통과 관련된 긴장성 두통 군에서 평균 49.937, 측두하악장애에 기인한 두통 군에서 평균 55.577를 나타냈으나 통계적으로 유의미한 차이는 없었다. 2. 기능 제한 점수는 두개주변압통과 관련된 긴장성 두통 군에서 평균 1.77, 측두하악장애에 기인한 두통 군에서 평균 2.32를 나타냈으나 통계적으로 유의미한 차이는 없었다. 3. 만성통증척도는 두개주변압통과 관련된 긴장성 두통 군에서 평균 2.02, 측두하악장애에 기인한 두통 군에서 평균 2.41를 나타냈으나 통계적으로 유의미한 차이는 없었다. 4. 우울증 정도는 두개주변압통과 관련된 긴장성 두통 군에서 평균 1.150, 측두하악장애에 기인한 두통 군에서 평균 1.049를 나타냈으나 통계적으로 유의미한 차이는 없었다. 5. 통증포함 비특이적 신체 증상 등급은 두개주변압통과 관련된 긴장성 두통 군에서 평균 1.117, 측두하악장애에 기인한 두통 군에서 평균 1.095를 나타냈으나 통계적으로 유의미한 차이는 없었다. 6. 통증비포함 비특이적 신체 증상 등급은 두개주변압통과 관련된 긴장성 두통 군에서 평균 0.939, 측두하악장애에 기인한 두통 군에서 평균 0.946을 나타냈으나 통계적으로 유의미한 차이는 없었다. 7. 하악기능과 관련된 기능제한은 두개주변압통과 관련된 긴장성 두통 군에서 평균 0.377, 측두하악장애에 기인한 두통 군에서 평균 0.387을 나타냈으나 통계적으로 유의미한 차이는 없었다. 두개주변압통과 관련된 긴장성 두통군과 측두하악장애에 기인한 두통군의 비교시 집단에 따른 척도점수의 평균에는 두 집단 사이에는 통계적으로 유사함이 관찰되었다. 이는 두개주변압통과 관련된 긴장성 두통과 측두하악장애에 기인한 두통이 임상적으로 유사한 축 II (Axis II)양상을 보인다는 것을 의미하며, 긴장성 두통의 일부분은 측두하악장애와 관련이 있다고 추론된다. 향후 긴장성 두통 진단시 측두하악장애에 대한 접근이 요구된다고 하겠다.

• Journal of Oral Medicine and Pain
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• 제48권4호
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• pp.152-158
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• 2023

Purpose: This pilot study aimed to evaluate changes in joint space (JS) using cone-beam computed tomography (CBCT) images of patients diagnosed with temporomandibular joint (TMJ) osteoarthritis (OA) and to determine the association between occlusal changes and JS. Methods: CBCT images were used to measure the anterior, superior, and posterior JSs of the sagittal plane. The differences in JS values over time and between groups were compared. The percentage change in the anteroposterior position of the mandibular condyle between groups was also analyzed. Results: Thirty-four subjects (mean age=43.91±20.13), comprising eight males (23.5%) and 26 females (76.5%), were divided into 18 patients with no change in occlusion (NCO) and 16 patients with a change in occlusion (CO) during TMJ OA. The JS measurements of the study subjects showed a decrease in anterior joint space (AJS) values over time. There was no difference in JS measurements between the groups at T1 and T2. AJS values measured at T1 were lower in the CO group than in the NCO group, but the difference was not statistically significant. In both groups, a posterior position of the mandibular condyle was initially observed with high frequency. However, there is a statistically significant difference in CBCT images taken after occlusal changes, with an increased frequency of condyles observed in the anterior or central positions. Conclusions: In conclusion, AJS decreased over time in TMJ OA, and the mandibular condyle became more anteriorly positioned with occlusal changes. Therefore, clinicians should diligently monitor mandibular condyle morphology and JS using CBCT, along with the patient's clinical symptoms, to treat and control TMJ OA effectively.