• Journal of Oral Medicine and Pain
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• 제47권2호
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• pp.78-86
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• 2022

An association between psychological factors and temporomandibular disorders (TMD) has been extensively explored for over 40 years, and a high prevalence of depression and somatization has been consistently reported in patients with TMD. Current evidence suggests that patients' somatic awareness can serve as a primer for TMD incidence and further contribute to the transition to chronic pain. However, the current understanding of somatization from a medical perspective is limited. The best way to address patients with TMD pain who have somatization is also unclear. Therefore, this paper aims to provide an overview of somatization in the context of pain psychology and address its clinical implications in the context of TMD pain.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권1호
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• pp.27-33
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• 2018

Background: Temporomandibular disorder (TMD) represents a subgroup of painful orofacial disorders involving pain in the temporomandibular joint (TMJ) region, fatigue of the cranio-cervico-facial muscles (especially masticatory muscles), limitation of mandible movement, and the presence of a clicking sound in the TMJ. TMD is associated with multiple factors and systemic diseases. This study aimed to assess the prevalence of TMD in Nepalese subjects for the first time. Methods: A total of 500 medical and dental students (127 men and 373 women) participated in this study from May 2016 to September 2016. The Fonseca questionnaire was used as a tool to evaluate the prevalence of TMD, and Fonseca's Anamnestic Index (FAI) was used to classify the severity of TMD. Results: The majority of the participants with TMD had a history of head trauma, psychological stress, and dental treatment or dental problems. The prevalence of TMD in Nepalese students was mild to moderate. Conclusions: The prevalence of TMD in Nepalese subjects was mild to moderate. The majority of the study subjects had eyesight problems, history of head trauma, psychological stress, and drinking alcohol and had received dental treatments.

• 한국엔터테인먼트산업학회논문지
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• 제13권7호
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• pp.461-468
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• 2019

본 연구의 목적은 상부 목 안정화 운동이 턱 관절 기능장애과 압통 역치에 미치는 효과를 알아보기 위하여 연구를 진행 하였다. 36명의 대상자를 상무목 안정화 운동 그룹과 대조군 두 그룹으로 설정하여 상부 목 안정화 운동은 압력센서를 활용하였으며, 연구를 총 4주간 주 3회 20분씩 진행하였다. 연구결과 개구범위에 있어서 상부 목 안정화군이 대조군보다 유의한 효과를 보였으며(p<.01, 95% CI: 8.074, 16.899), 우측 치우침에서 상부 목 안정화 운동군이 대조군보다 유의한 효과를 보였다(p<.01, 95% CI: .826, 3.243). 압통 역치의 변화에서는 관자근(p<.01, 95% CI: .251, 1.382)과 깨물근(p<.01, 95% CI: .462, 1.826) 모두 상부 목 안정화군이 유의한 향상을 보였다. 본 연구결과 턱 관절 기능장애 환자에게 상부 목안정화 운동이 턱 관절 장애에 효과적이었다. 턱 관절 장애를 경험하고 있는 환자들에게 더욱더 효과적인 중재방법을 제공할 수 있을 것이며, 나아가 턱 관절 장애로 인한 고통받고 있는 환자들에게 새로운 접근방법을 제시할 수 있을 것이다.

• Journal of Oral Medicine and Pain
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• 제45권3호
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• pp.56-64
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• 2020

Purpose: Temporomandibular disorders (TMD) is a mosaic of clinical signs and symptoms that can be regarded as a set of phenotypes that are affected by various factors including pain sensitivity, pain disability, sleep and psychological functioning. The aims of this study were to evaluate association of pain experience, sleep quality and psychological distress with different phenotypes of TMD patients. Methods: This retrospective study included a cohort (n=1,858; 63.8% for female, mean age=34.9±15.9 years) of patients with TMD. A set of self-administered questionnaires concerning pain interference (Brief Pain Inventory), pain disability (Graded Chronic Pain Scale), sleep quality (Pittsburg Sleep Questionnaire Index), psychological distress (Symptom Checklist-90 revised), and pain catastrophizing (Pain Catastrophizing Scale) were administered to all participants at the first consultation. All TMD patients were classified into four groups including TMD with internal derangement without pain (TMD_ID, n=370), TMD with joint pain (TMD_J, n=571), TMD with muscle pain (TMD_M, n=541) and TMD with muscle-joint combined pain (TMD_MJ, n=376). Results: The female ratio was particularly high in the group with TMD_MJ (p=0.001). The patients with muscle pain and both muscle and joint pain had longer symptom duration (p=0.004) and presented significantly higher scores in pain experience (p<0.001), subjective sleep quality (p<0.001), pain catastrophizing (p<0.001) and psychological distress (p<0.05) except for paranoid-ideation than the groups with only joint problems. Conclusions: The results of this study highlight the importance of multi-dimensional approach that consider pain disability, sleep quality, and psychological functioning in the management of TMD with muscle component. This study would contribute to a better understanding of interaction between heterogeneous TMD and multiple risk factors in order to build tailored treatment based on different phenotypes.

• 대한치과의사협회지
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• 제46권5호
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• pp.308-314
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• 2008

The risk of temporomandibular joint disorder (TMD) can be increased during dental treatment due to excessive mouth opening and change of occlusion. The aim of this study is to find the relationship between dental treatment and TMD in the patients who developed TMD after dental treatment. The subjects of this study were 21 patients, who developed TMD after dental treatment and were treated with active TMD therapy in Seoul National University Bundang Hospital from June 2003 to February 2007. The subjects were examined with preceding dental treatment, symptom, diagnosis, treatment method of TMD and prognosis of TMD. The obtained results were as follows. 1. Preceding dental treatments were : Implant treatment, 14 cases ; Tooth extraction, 3 cases and others. 2. TMD symptoms were : pain on TMJ, 12cases : Sound on TMJ, 3cases ; Mouth opening limitation, Headache and others. 3. Diagnoses of TMD were : Synovitis and/or capsulitis, 10 cases ; 8 cases of Internal derangement and others. 4. Most TMD were treated by stabilization splint. 5. Prognoses of TMD were : Improvement, 6cases ; sustained 11 cases. In conclusion, the risk of TMD is increased during implant treatment. Prognoses of TMD after dental treatment were bad. It might be that these patients were non-cooperative and have distrust of dental treatment. Because the overloading on TMJ is possible in dental treatment of patients with underlying TMD, prior explanation and knowledge TMJ treatment are very important in these cases.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권5호
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• pp.232-236
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• 2018

Objectives: Hormonal changes during menopause alter a woman's susceptibility to some disorders. Information regarding the prevalence of temporomandibular disorder (TMD) in menopausal women is limited in the literature. In this study, the prevalence and severity of TMDs were compared between menopausal and non-menopausal women. Materials and Methods: The study included 140 women (69 premenopausal and 71 postmenopausal) 45 to 55 years of age that were examined in Shiraz Dental School, Shiraz in Iran. The Helkimo clinical dysfunction index (Di) was used to evaluate temporomandibular joint (TMJ) dysfunction. The data were analyzed using chi-square and Fisher's exact tests. Results: Occurrence of TMD was significantly higher in menopausal than non-menopausal women (P<0.001). All the TMD criteria based on Helkimo Di except range of mandibular movement were significantly more common in menopausal women. The range of mandibular movement was not significantly different between menopausal and non-menopausal women (P=0.178). Conclusion: The results from this study show that TMD can be considered more common and severe in menopausal than non-menopausal women. This finding indicates that, similar to other conditions in menopausal women such as arthritis and osteoporosis, TMD should be taken into consideration by dental and medical professionals.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권5호
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• pp.399-408
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• 2005

In the progression of the Temporomandibular Joint Disorder(TMD), not only deformation and perforation of disc occur. But also fibrotic adhesion and inflammatory changes to the retrodiscal tissue can be seen in addition to the condylar degenerative change (e.g. osteoarthritis). However, the correct diagnosis,?planning for appropriate treatment, and prediction of prognosis are limited, because there are no means to stage the progression of the disorder. In this study relative signal intensity of retrodiscal tissue in MRI and the synovial fluid concentration of matrix metalloproteinase-2 (MMP-2), MMP-9, and Interleukin-6(IL-6) in the 23 temporomandibular joints(TMJ), from 17 patients with TMD were evaluated as a possible diagnostic marker. The relative signal intensity of retrodiscal tissue was referenced to brain gray matter with same region of interest(ROI) size. The concentrations of MMP-2, MMP-9, and IL-6 were evaluated by Enzyme Linked Immunosorbent Assay (ELISA). The collected data were compared with condylar degenerative change, joint effusion and disc position observed in MRI. The relative signal intensity of the retrodiscal tissue was increased significantly when degenerative changes were present. In addition, there was significantly high signal intensity in the presence of a disc displaced without reduction. The concentration of IL-6 was significantly increased when condylar degenerative change was no observed. And there were no changes in the levels of IL-6 according to disc position and joint effusion measurement. Moreover, there were no significant relevance between the concentration of total MMP-2 and active MMP-9 in synovial fluid, relative to degenerative changes in the mandibular condyle, to joint effusion, and to disc position observed on MRI images. In conclusion, the relative signal intensity of the retrodiscal tissue can be regarded as a mean of diagnosing the procession of TMD in a non-invasive manner. But more additional studies are required for the levels of MMP-2. MMP-9, and IL-6 to determine their potentials as a diagnostic marker for TMD.

• Physical Therapy Rehabilitation Science
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• 제9권4호
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• pp.244-251
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• 2020

Objective: Physical therapy techniques are required for patients with temporomandibular joint disorder (TMD), but the effects of treatment have not been compared. Therefore, effects of transcutaneous electrical nerve stimulation (TENS) and low level laser (LLL), which are most commonly used interventions, were compared. Design: Randomized controlled trial. Methods: Thirty-six participants with pain in the temporomandibular joint were enrolled, and 12 participants were randomly assigned to either the TENS group, LLL group, or placebo group. Each intervention was performed for a total of 6 sessions for 2 weeks. For the evaluation of the participants, the mouth opening (MO), pressure pain threshold (PPT), and stress were measured at three time periods: baseline, post-test, and follow-up at 2 weeks. Results: Significant interaction between groups according to each evaluation point was found only in PPT-masseter (p<0.05). The evaluation time point at which a significant difference appeared was at the post-test and follow-up at 2 weeks time periods. As a result of the post-test, the LLL group showed a significant improvement compared to the TENS group (p<0.05), and at 2 weeks follow-up, the TENS group showed a significant improvement compared to the placebo group (p<0.05). Conclusions: In this study, an experiment was conducted to compare the treatment effects when TENS, LLL, and placebo were given to patients with TMD. In addition, by quantitatively presenting the effect size of each treatment, this study suggests clinical use of TENS and LLL treatment for TMD.

• 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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• 제43권2호
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• pp.134-137
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• 2017

Giant cell tumor (GCT) of the craniofacial bones has been reported but they are not common. This tumor occurs more often in women than in men and predominantly affects patients around the third to fifth decade of life. GCTs are generally benign but can be locally aggressive as well. We report a case of GCT involving the temporomandibular joint (TMJ), which was initially thought to be temporomandibular disorder (TMD). A 22-year-old female presented with swelling and pain over the right temporal region for 18 months associated with jaw locking and clicking sounds. On examination, her jaw deviated to the right during opening and there was a $2{\times}2$ cm swelling over the right temporal region. Despite routine treatment for TMD, the swelling increased in size. Computed tomography and magnetic resonance imaging of the brain and TMJ revealed an erosive tumor of the temporal bone involving the TMJ which was displacing the temporal lobe. Surgical excision was done and the tumor removed completely. Histopathological examination was consistent with a GCT. No clinical or radiological recurrence was detected 10 months post-surgery.