• 한방재활의학과학회지
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• 제26권2호
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• pp.61-74
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• 2016

Objectives The purpose of this research is to investigate recent clinical studies of Temporomandibular Joint Disorder in China. Methods We investigated recent clinical studies of Oriental Medicine therapies in traditional Chinese medical journals for Temporomandibular Joint Disorder through CNKI search. 20 clinical articles published from 2010 to 2015 were analyzed. This study examined the authors, published years, types of study designs, criteria for diagnosis and evaluation, periods, purposes of study and classified articles by techniques of treatment. Results Most of articles were classified as RCT. TMD was diagnosed by symptoms in a high proportion of articles. The criteria for evaluation that most frequently used were grading scale, but there was a lack of objectivity. The techniques of treatment were Tuina, acupuncture, herb medicine, electrotherapy, splint, PNF, congnitive behavior therapy, laser therapy, magnetic therapy. Conclusions In order to develop treatment of TMD in the Korean medicine, clinical studies for various therapies on a high level and cooperative studies between medical communities are needed.

• Journal of Acupuncture Research
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• 제40권3호
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• pp.214-237
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• 2023

This study aimed to evaluate the clinical efficacy and safety of acupuncture and electroacupuncture for temporomandibular joint disorder (TMD). We searched 11 databases to find randomized-controlled trials (RCTs) published between January 2018 and January 2023 that used acupuncture and electroacupuncture to treat patients with TMD. We performed a meta-analysis of 18 RCTs involving 1,109 patients. Nine studies reported that the treatment and control groups showed improvement in the evaluation index post-treatment. The results of the meta-analysis showed that the treatment groups receiving acupuncture combined with manual therapy had significantly improved visual analog scale score and dysfunction index than the control groups receiving manual therapy. Moreover, the treatment groups receiving acupuncture combined with Western medicine had statistically improved maximum mouth opening than the control groups using Western medicine. In conclusion, acupuncture and electroacupuncture have clinical effects on TMD patients. Given that 11 studies were obtained from the Chinese database, a regional bias would be considered. Furthermore, the included studies had high a risk of bias in terms of randomization, concealment, and blinding. Further studies are required to correct these limitations.

• Journal of Oral Medicine and Pain
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• 제41권1호
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• pp.30-33
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• 2016

Malignant tumors located in the head and neck areas intermittently show symptoms similar to a temporomandibular disorder (TMD). In our case, a patient who first visited us complaining of TMD-like symptoms, such as trismus and temporomandibular joint (TMJ) pain on the left side, was identified as a sufferer of adenoid cystic carcinoma (ACC) that arose from the left maxillary sinus. The patient may have a TMD symptom, but we are skeptical because the patient also complained of a spontaneously developed numbness on the same side of his upper lip. We observed the panoramic radiograph closely and found the blurred maxillary sinus inferior wall. Dental cone-beam computed tomography confirmed the tentative diagnosis of malignancy on the maxillary sinus. After he had been referred to the Department of Otolaryngology, the diagnosis of the ACC was confirmed. Adequate diagnosis is vital for a quick treatment of the malignancy. There are some keys for differential diagnosis of TMD-like symptoms.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권5호
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• pp.375-380
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• 2009

Objective : Trauma has been a controversial issue although it has been considered to be a major factor for the temporomandibular disorder(TMD). We evaluated the relationship between macrotrauma or microtrauma and TMD. Methods : This study was performed in patients with TMD undergoing treatment at SNUBH from October 2006 to January 2007. Sixty one male patients and 166 female patients(total 227) were included and the average age was 34 years(ranging from 14 to 85 years). We investigated the possible etiologic factors, diagnosis and treatment with the review of medical records and radiography. Chronic pain, depression, somatic score(including pain item), somatic score(excluding pain item) were evaluated on the basis of diagnostic index from the Research Diagnostic Criteria on TMD. Results : Eighteen patients(7.9%) out of 227 patients suffered from TMD as a result of macrotrauma. Ninety four(41.4%) patients had microtrauma and six patients(2.6%) had both macro- and microtrauma(etiologic factor). The main symptoms included pain. joint noise and mouth opening limitation while the other symptoms were headache and tinnitus. The patients had suffered from TMD for average 41 weeks (ranging from 1 to 480 weeks). 116 patients took splint as a major treatment. As a prognosis, 19 patients(8.4%) recovered completely. 26(11.0%) had improvement and 181(80%) had persistent symptoms. 1 patient(0.4%) underwent an arthroplasty. Diagnostic index from RDC chart showed that macrotrauma was the highest score(except depression score) among the other etiologic factors. Conclusion : This study showed that macro- and microtrauma can be considered to be the major etiologic factors of TMD, which also affect the chronic, depression and somatic discomfort.

• Journal of Oral Medicine and Pain
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• 제36권1호
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• pp.39-51
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• 2011

본 연구는 측두하악장애의 연구 진단 기준(Research Diagnostic Criteria for Temporomandibular Disorder; RDC/TMD)을 이용하여 구분된 측두하악장애(Temporomandibular Disorder; TMD) 환자를 대상으로 안면의 골격적 양상과 TMD 사이의 연관성을 규명하고 교정 환자의 진단과 치료에 있어 RDC/TMD의 활용 가능성을 제시하고자 하였다. 서울대학교 치과병원 구강내과에 측두하악장애의 진단과 치료를 위해 내원한 여성 환자들의 의무 기록 및 방사선사진을 검토하였으며 환자의 연령이 18세 미만이거나 전신 질환, 골격적 기형 또는 측두하악관절 부위의 외상 병력이 있는 경우는 제외되었다. 총 96명의 여성 환자로부터 얻은 RDC/TMD Axis I 을 포함한 임상 검사 결과와 측방 두부규격방사선사진 (lateral cephalogram), 파노라마 방사선사진(panoramic radiograph) 및 횡두개 방사선사진(transcranial radiograph)을 이용한 방사선적 검사 결과를 분석하였다. RDC/TMD를 이용하여 집단을 분류한 후 측방 두부규격방사선사진의 각도 및 길이 요소들을 계측하여 안면의 골격 관계, 상하악 관계 및 치열 관계를 분석하였다. 통계적 분석법으로는 독립표본 t-검정(independent t-test), 일원분산분석(one-way Analysis of Variance; one-way ANOVA) 및 카이제곱 검정(chi-square test)을 이용하였고 다음과 같은 결과를 얻었다. 1. 근육 문제를 진단하는 RDC/TMD Axis I 의 제 1 군 측두 두부방사선적 특징에서 통계적 유의성이 인정되지 않았다. 2. 관절원판 변위를 임상적으로 진단하는 제 2 군에서는 개구 장애를 동반하지 않는 비정복성 관절원판 변위가 있는 경우 관절원판 변위가 없는 정상 집단에 비하여 articular angle이 큰 것으로 나타났다. 3. 관절통, 관절염 및 관절증을 진단하는 제 3 군에서는 articular angle, FMA, Bjork sum, posterior facial height 및 facial height ratio에서 유의한 차이가 있는 것으로 분석되었다. 4. TMD 진단군과 골격적 양상 사이의 관계를 단순화하기 위하여 RDC/TMD Axis I 각 군을 양분법적으로 분류한 뒤 동일 한 방식으로 분석을 시행하였다. 그 결과 제 1 군에서는 overjet, 제 2 군에서는 articular angle, facial height ratio 및 IMPA, 마지막으로 제 3 군에서는 articular angle, gonial angle, facial convexity, FMA, Bjork sum, posterior facial height, facial height ratio 및 ANB angle에서 유의한 차이를 보였다. 이상의 RDC/TMD Axis I 을 이용하여 진단된 측두하악장애 환자를 대상으로 안면의 골격적 양상과 TMD 사이의 연관성 을 분석한 결과로부터 RDC/TMD Axis I 임상 진단에 따라 진단한 측두하악장애 환자 중 제 2 군과 제 3 군의 환자들에서 측두하악장애와 관련된 것으로 알려진 하악골의 후하방 회전으로 인한 골격적 차이가 존재함을 확인하였다. RDC/TMD Axis I은 교정 전 혹은 교정 치료 진행 중에 임상 검사 및 일반 방사선사진으로부터의 제한된 정보를 바탕으로 교정 치료 중 고려하여야 할 TMD 환자를 감별하는데 유용한 정보를 제공할 수 있을 것이다.

• 척추신경추나의학회지
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• 제4권1호
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• pp.65-73
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• 2009

Objectives : The propose of this study is to analyze characteristics with sex, age, motivation, symptom, Impression, treatment effect about temporomandibular disorder patients. Method : We performed a retrospective study of 52 patients who visited the Jaseng Hospital of Oriental Medicine, from August 2008 to October 2008. Result : Women occupied the most part. And 27 persons in the 20th are the most distribution of age. The majority of patients occured the symptom for no reason. In the distribution of symptoms, TMD pain(88.46%), Click sound(82.69%), neck pain(52.92%), headache(38.46%), lumbago(21.15%) happened. In the impression through radiological diagnoses, The majority of patients diagnosed Straightening of cervical lordotic curvature. Oriental medical treatment showed a very valuable effect on improvement of TMD symptom. Conclusion : The results showed a valuable treatment effect of temporotandibular disorders on Oriental medical treatment. Therefore this work have the necessity of continuous study and observation and will help us to understand the features of patients who visiting the TMD clinic of Jaseng Hospital of Oriental medicine.

• 턱관절균형의학회지
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• 제9권1호
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• pp.18-23
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• 2019

Objectives: The aim of our study was to report clinical improvement of a patient who suffered from Temporomandibular Disorder (TMD) being treated with Korean Medical treatments and Intraoral Balancing Appliance (IBA). Methods: During the admission period, the patient was treated with acupuncture, cupping, Korean Medicine, Chuna therapy and FCST (Functional Cerebrospinal Therapy) every day. And we observed patient's condition by Numeric Rating Scale (NRS), Pain Disability Index (PDI), EQ-5D-5L (Five-level EuroQol-5 dimensions), and assessment about range of motion(ROM) for temporomandibular joint and cervix. Results: After treated for 4 weeks, the patient's NRS, PDI, EQ-5D-5L and ROM were improved. Conclusions: Korean Medical treatments including FCST are estimated to be effective for patients with TMD. But the case was only one, so more cases and further research is needed to prove the effectiveness of the treatment.

• 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.

• Imaging Science in Dentistry
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• 제43권4호
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• pp.245-251
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• 2013

Purpose: This study was performed to evaluate the relationship between anterior disc displacement and effusion in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). Materials and Methods: The study subjects included 253 TMD patients. MRI examinations were performed using a 1.5 T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the MRI findings, temporomandibular joint (TMJ) disc positions were divided into 3 subgroups: normal, anterior disc displacement with reduction (DWR), and anterior disc displacement without reduction (DWOR). The cases of effusion were divided into 4 groups: normal, mild (E1), moderate (E2), and marked effusion (E3). Statistical analysis was made by the Fisher's exact test using SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: The subjects consisted of 62 males and 191 females with a mean age of 28.5 years. Of the 253 patients, T1- and T2-weighted images revealed 34 (13.4%) normal, DWR in 103 (40.7%), and DWOR in 116 (45.9%) on the right side and 37 (14.6%) normal, DWR in 94 (37.2%), and DWOR in 122 (48.2%) joints on the left side. Also, T2-images revealed 82 (32.4%) normal, 78 (30.8%) E1, 51 (20.2%) E2, and 42 (16.6%) E3 joints on the right side and 79 (31.2%) normal, 85 (33.6%) E1, 57 (22.5%) E2, and 32 (12.7%) E3 on the left side. There was no difference between the right and left side. Conclusion: Anterior disc displacement was not related to the MRI findings of effusion in TMD patients (P>0.05).

• Journal of Korean Dental Science
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• 제1권1호
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• pp.15-21
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• 2008

Purpose : This epidemiological research was conducted to investigate the relationship between the groups of TMD and the behavioral, psychological, and physical symptoms through RDC/TMD. Subjects and Methods : The subjects of this research were the 286 patients who had visited Seoul National University Bundang Hospital; their common chief complaint was temporomandibular discomfort. The mean age of the patients was 32.9 from 11 to 85, and the number of men and women was 67 and 219, respectively. The patients were examined through clinical and radiological methods and diagnosed by 1 investigator. They were divided into 3 groups: myogenous group (group 1), arthrogenous group (group 2), and combined group (group 3). The behavioral, psychological, and physical symptoms were evaluated through questionnaires on RDC/TMD. Specific items were selected to calculate the graded chronic pain (characteristic pain intensity, disability points), jaw disability, depression, and non-specific physical symptoms (pain items included/excluded) in the questionnaire. One-way ANOVA, Kruskal-Wallis test, and chi-square test were applied as statistical methods. Results : As a result of classifying temporomandibular disorder in this study, the patients were distributed as follows: 9.1% of group 1, 79.7% of group 2, and 11.2% of group 3. In the analysis of graded chronic pain (characteristic pain intensity, disability points), jaw disability, and non-specific physical symptoms (pain items included/excluded), group 3 had the highest score, and the difference was significant (p<0.001). Moreover, the depression score of group 3 was significantly higher than groups 1 and 2 (p<0.05). Note that that the second order of jaw disability score was group 2, on the other hand, those of the other groups were group 1. Conclusion : Myofascial pain could be assumed to be related closely to the behavioral, psychological, and physical symptoms except jaw disability compared to joint pain through RDC/TMD.