• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.5
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• pp.497-506
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• 2000

This study is comprised of data obtained from the files of 346 patients with temporomandibular disorders. All patients were diagnosed, treated and followed in the Department of Dentistry at the Inha university hospital, Incheon, Korea. The patients had treated with medications, physical therapy, occlusal splint and arthrocentesis. The study data were obtained from the medical records and telephone interviews that were conducted by research assistants. The results were as follows 1. The patient's main complaint was pain(77%), and mouth opening limitation was 17%. 2. An analysis of the medical records of the 346 patients disclosed that 82% were improved and 17% had no improvement when they were dismissed. 1% of the patients had become worse during therapy. 3. A success rate of 82% was achieved when medication assisted physical therapy was included. In the current status at the telephone interview, 270 patients(89%) reported that they were doing well with 56% describing themselves as asymtomatic and 32% experiencing only minor residual or recurrent symptoms. 11% regarded themselves as unimproved and worse. 4. In the current status of the unsuccessfully treated patients by medications and physical therapy, 64% of patients were doing well(3% as asymptomatic and 56% as only minor residual or recurrent symptom). But 36% of patients was reported as unimproved and worse. 5. TMJ has a remarkable adaptive potential and TMJ disorder has a natural history of spontaneous fluctuations and favorable prognosis during the subsequent natural course. 6. In the treatment of the temporomandibular disorders, there is a treatment ladder, starting with the simplest and least expensive treatment, that is ascended until resolution of the patient's symptoms occur. These findings suggest that conservative reversible therapies are both sufficient and appropriate for management of temporomandibular disorder in most patients. Major alterations of mandibular position or dentoalveolar relationships do not appear to be necessary for obtaining either short term or long term success and therefore they can be generally regards as inappropriate treatment for this disorder. The fact that physical therapy is non-invasive and does not appear to be fraught with irreversible changes, makes it a very applicable vehicle in the area of clinical TMJ disorder management.

• Journal of Oral Medicine and Pain
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• v.23 no.4
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• pp.361-368
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• 1998

In order to evaluate the clinical features of the rcurred patients with temporomandibular disorders, 52 patients were subjected at the Dept. of Oral Medicine, PNUH from 1985 through 1996. As related to gender, duraton and diagnosis, Ll the relate factors-multiple diagnosis, emotinal problem, history of treatment, parafunctional habit, life distrubance, and trauma were analyzed. The obtained results were as follows : 1. The patients with multiple diagnosis were 83 percent and more often seen in women, chronic group and muscle-joint disorder group. 2. Duration of retreatment in chronic group and muscle-joint disorder was longer. 3. The patients with oral parafunctional habits were 89 percent and more often seen in women, chronic gorup, muscle-joint disorder group. 4. the Recurred patients showed 46 percent in history treatment, 42 percent in life distrubances, 39 percent in macrotrauma and 12 percent in emotional problem.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.18 no.1
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• pp.81-136
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• 1988

The aim of this study was to determine whether T.M.J. tomographic examination yielded significant differences in condyle positions among asymptomatic, myalgia, derangement, and arthrosis groups of T.M.J. disorders. The author obtained sagittal linear tomograms of right and left T.M.Js. of 36 asymptomatic, 22 myalgia, 54 derangement, and 31 arthrosis patients taken at serial lateral, central, and medial sections in the intercuspal position after submentovertex radiographs analyzed. With the dual linear measurements of the posterior and anterior interarticular space, condyle positions were mathematically expressed as proportion. All data from these analysis was recorded and processed statistically. The results were obtained as follows. 1. In asymptomatic group, radiographically concentric condyle position was found in 50.0% to 65.4% of subjects, with a substantial range of variability. No significant differences existed between men and women and also between right and left T.M.Js. for condyle position. 2. In women, significant difference for mean condyle position of left lateral section of each diagnostic category existed between derangement and myalgia groups (P<.05). Also that of left central section existed between derangement and myalgia groups, and that of left medial section existed between derangement and myalgia groups (P<.05). 3. In main-symptom side, condyle position in myalgia group was more concentric, and condyle position in derangement group was more posterior. This showed significant differences between derangement and myalgia groups in lateral, central, and medial sections of main- symptom sides, and only between derangement and myalgia groups in central section of contra-lateral sides (P<.05). Condyle position in arthrosis group was broadly distributed among all positions. 4. In contra-lateral side, significant difference for mean condyle position of central section of each symptomatic group existed between derangement and myalgia groups (P<.05). Condyle position in derangement group was more posterior. The distribution of the condyle position of contra-lateral side in patients with unilateral symptoms was similar to that of main-symptom side in each symptomatic group. No significant difference existed between main-symptom and contra-lateral sides. 5. For internal derangement subgroups, condyle position in reducible disc displacement group was more posterior than non-reciprocal and locking groups, but there was no significant difference. 6. From 16 to 25 years, significant difference for mean condyle position of medial section of main-symptom side of each symptomatic group existed between myalgia and derangement groups (P<.05).

• Journal of Dental Rehabilitation and Applied Science
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• v.31 no.2
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• pp.86-95
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• 2015

Purpose: The aim of the study was to evaluate the subjective symptoms and clinical signs through the TMD-questionnaire, clinical examination and radiography against the many instrumental performers and to investigate the association between playing instruments and TMDs. Materials and Methods: A total of 803 instrumental performers received TMD-related questionnaire and evaluations of prevalence and disease distribution were performed. Among those who reported at least one symptom of TMD, 70 volunteers visited in clinic then received clinical examination and radiography for diagnosis and evaluations of prevalence and disease distribution were performed. 70 subjects were divided into three groups as woodwind, brass wind, string. Comparative analysis of disease distribution was performed. Results: Among 803 instrumental performers, 610 people (75.97%) were reported to one or more symptoms of TMD. The most frequent symptom was click (29.68%).70 subjects underwent a clinical examination and radiography survey results, the most frequent symptom was a click (29.75%). Most commonly diagnosed disease was a myofacial pain (30.53%).Comparison of the three groups, a significant difference was not observed in the clinical sign. But among subject symptom, muscle pains howed significant differences in accordance with the Group (P = 0.024). During the 70 people who underwent clinical examination, 66 people (94.3%) showed moderate to severe attrition, mild to severe tongue ridging, mild to severe cheek ridging assigns of parafunction. Conclusion: Instrumental performers showed a high prevalence of TMD and the most of the musicians with temporomandibular disorder had bruxism or clenching habits.

• Journal of Oral Medicine and Pain
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• v.30 no.4
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• pp.433-446
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• 2005

The purpose of this study was to investigate the sociopsychological factors which might influence the course of the temporomandibular disorders and to develop models for prediction of treatment outcome related to pain, dysfunction and sound. For this study, 268 patients with temporomandibular disorders were selected from the patients presented to department of Oral Medicine, Wonkwang university dental hospital. Chief complaints of these subjects were largely grouped into three categories such as pain, dysfunction and sound, and 10 cm visual analogue scale(VAS) was used to record the state of the three complaints every visit and Treatment Index(VAS TI) was calculated from VAS. All the forty-two items obtained from clinical examination or questionnaire were statistically processed with $SPSS^{(R)}$ windows. The results of this study were as follows: 1. The items showed a difference between male and female subjects were maximum mouth opening, palpation score, jaw jerk during mandibular movement, and sleep disturbance. Among questionnaires such as SRRS, HAD scale and PSQI, the HAD scales showed the most highly significant correlation with the each scale item of the SCL-90R. 2. Among the groups classified by VAS TI, the group with the lowest VAS TI showed the highest VAS score in the start of treatment but showed the lowest score in the end of treatment, without respect to the type of chief complaint. From these results, it is assumed that the active treatment duration for the subjects with lower VAS score in the first visit would be longer than the subjects with higher score with the somewhat poor treatment outcome. 3. With regard to all the three complaints, the items showing significant effect in the model for prediction of treatment outcome were from questionnaire, except one item, maximum mouth opening, which suggest that the sociopsychological factors would be strongly related to development and progress of the symptoms.

• Journal of Oral Medicine and Pain
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• v.25 no.2
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• pp.229-234
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• 2000

The patient, 62-years-old woman, had a constant dull pain in the right mandible and an intermittent spontaneous burning sensation of the mouth. The pain began 6 months ago. About 5 years ago, a trauma in her right mandible which was so severe that kept her in the hospital for 2 days. This was followed by mouth opening disturbance with pain for about 2 years. However, she did not have a treatment for the temporomandibular disorder symptoms. After then, she experienced the trigeminal neuralgia characterized by an electrical pain which lasted about 30 minutes in her right face and head when touching the skin or hair. After taking a year course treatment of trigeminal neuralgia, the symptom disappeared. The pain was a constant dull pain and a intermittent burning pain which are contradictory. And the pain responded to various modalities such as physical therapy, anti-inflammatory drug, carbamazepine, and amitriptyline, among which carbamazepine was most effective. The diagnosis was clinically made as an atypical trigeminal neuralgia. The term 'atypical' is used when there is something unknown and the problem is not identified. It is thought that an atypical pain may be approached in the perspective of chronic pain, neuropathic pain, and myofascial pain, the mchanisms of which are poorly understood. As the knowledge of pain physiology improves, there needs to be modification and re-evaluation. Pain disorders must be classified on the basis of an understanding of the underlying mechanism and etiology.

• Journal of Oral Medicine and Pain
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• v.23 no.4
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• pp.387-401
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• 1998

This study was performed to investigate the emotional state related to dental fear, hospital anxiety and depresison, and frequency of stress symproms of orofacial region. For this study, Dnetal Fear Surfey(DFS) scale, the Hospital ANxiety and Depression(HAD) scale, and Stress Symptom Questionnaire(SSQ) designed by the author were used in 549 dental outpatients. Dental Fear Survey scale is composed of avoidance of dentistry(AVOI), physiologic response scale(PRS) and dental stimulus response scale(DSRS). The Hospital anxiety and Depresiosn scale is composed of hospital anxiety(HA) and hospital depressoin (HD). Data were analyzed statistically with SPSS program and the results were as follows : 1. The item of the highest positive response rate in DFS scale was 'feeling drill'(82.0%), and in the HAD scale was ' feel as if I am slowed down'(84.1%). 2. Mean score of AVOI, PRS, DSRS and HD were higher in the older group(>25yr) than the yoiunger group(<25yr) and female patients showed higher score of DSRS, HA than male patients. 3. Mean number of items of stress symptoms in extraoral region were 3.4, and in intraoral region, were 4.7. Tongue wymptoms were increased in the older toup and female patients had more stress symptoms than male patients. 4. Correlation between DFS scale and HAD scale were significantly positive and these scales were also apositively correlated with tongue symptoms. 5. As for treatment types, the patients treated in the department of periodontics,conservative dentistry, and oral surgery showed higher score of DFS scale than the patients with temporomandibular disorders or treatedin the department of orthodontics.

• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.233-242
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• 2012

The purposes of this study were to compare psychological profiles, to investigate the differences in the clinical characteristics, and to compare treatment outcomes between myogenous pain and arthrogenous pain subgroups of temporomandibular disorder (TMD) based on Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD). Two hundred and fifty two patients diagnosed as TMD were divided into three groups based on the RDC/TMD axis I diagnostic guidelines; myogenous pain group, arthrogenous pain group, and mixed pain (both myogenous pain and arthrogenous pain) group. RDC/TMD history questionnaire was administered to each patient and depression, somatization, jaw disability, pain intensity, disability days, and graded chronic pain scale were analyzed. Bruxism, clenching, insomnia, headache, and unilateral chewing were assessed in a standardized TMD dysfunction questionnaire and the duration of onset, chronicity of pain, treatment period, the effectiveness of the treatment, and improvement of symptoms also analyzed. Myogenous pain group had higher depression (p=0.002), and somatization scales (p<0.001) than the arthrogenous pain group. Mixed pain group showed higher pain intensity (p=0.008), disability days (p<0.001), graded chronic pain scale (p=0.005), somatization (p<0.001), and depression scores (p=0.002) than the arthrogenous pain group. Jaw disability did not show any significant differences among the three groups (p=0.058). Arthrogenous pain group reported more limitation of mouth opening than myogenous pain group (p=0.007). Duration of onset showed that the arthrogenous pain group had lowest prevalence of chronicity among three groups (p=0.002). Mixed pain group patients showed lowest symptom improvements among three groups (p=0.007). Multiple linear regression analysis results showed that the treatment effectiveness was significantly associated with somatization score (${\beta}$=-0.251, p=0.03).

• Journal of Oral Medicine and Pain
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• v.21 no.1
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• pp.67-78
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• 1996

This study was performed to compare the TMJ sounds by means of vibration-related items by Sonopak such as integral, high integral, above 300/(0-300) ratio, peak amplitude, peak frequency and median frequency before and after occlusa1 splint therapy as well as counselling, physical modalities. For this study 22 patients with craniomandibular disorders (CMDs) were selected and examined by routine diagnostic procedure for CMDs including Transcranial and Panoramic radiographs and were classified into 3 CMDs subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Visual analogue scale (VAS) about joint sound was recorded during treatment period and VAS treatment index (VAS Ti) was calculated from the VAS data and treatment duration. The author evaluated and compared treatment results by several parmeters such as symptom duration, timing of joint sound, parafunctional habits, trauma, and diagnostic classification. The obtained results were as follows : 1. Before the treatment, the highest value of peak amplitude was observed in disc displacement with reduction group and value of median frequency was highest in degenerative joint disease group. In addition the highest values of peak frequency and ratio ware observed in degenerative joint disease group, though they were not significant. Furthermore the lowest value of high integral was observed in disc displacement without reduction group and though it was not significant, value of integral was lowest in that group. 2. Among 3CMDs subgroups disc displacement with reduction group showed the significantly decreased value of high integral and degenerative joint disease group had the significantly decreased value of integral after conservative treatment including occlusal splint therapy. Conclusively conservative treatment including occlusal splint therapy vay be effective in the treatment of CMDs including TMJ sound. 3. Fair prognosis for conservative treatment was observed in acute group under 6 months than chronic group, 6 months over in symptom duration but there was no statistical difference. The result for conservative treatment was observed slightly poor in subjects with bruxism, clenching, unilateral chewing habit and trauma history but there were no statistical differences.

• Journal of Oral Medicine and Pain
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• v.35 no.1
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• pp.83-91
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• 2010

Objectives: This study aimed to assess the characteristics of temporomandibular disorder (TMD) symptoms and to determine the correspondence between TMD symptoms and clinical examination findings. Material and methods: A total of 218 patients (143 females and 75 males; age=$31.3{\pm}14.0$) were enrolled in this study who completed a questionnaire and underwent a clinical examination and radiographic assessment. Patients were asked about all the symptoms and complaints, including onset or duration, and locations of the symptoms. Clinical examination included amounts of mouth opening, palpable temporomandibular joint (TMJ) sounds, and tenderness to palpation of the TMJ and all masticatory muscles. Tenderness scores obtained from palpation of the masticatory system were summated to define the variables for further analysis. Results: Pain was the most frequently reported symptom (78.9%), followed by joint sounds (45.4%), and limitation in mouth opening (17.0%). Jaw pain comprised 91.9% of pain complaints. The subjective intensity of jaw pain was low to medium in most patients (93.7%), but it was poorly correlated with the sum of tenderness scores of the TMJ and masticatory muscles (Kendall tau = 0.084). In contrast, the side in which pain was reported by patients was well associated with the clinical examination results (pain of the right side, p < 0.001, and left side, p < 0.001). There was moderate agreement in TMJ sounds between the side identified by patients as symptomatic and clinical examination findings (kappa = 0.482). Finally, patients who complained of restricted mouth opening showed about a 10 mm less opening in all three measurements, compared to other patients (p < 0.001). Conclusion: The most frequent symptoms reported by TMD patients were jaw pain, TMJ sounds, and mouth opening limitation. The side of jaw pain, the side of TMJ sounds, and the presence of opening limitation were highly concordant between symptom reports and examination findings.