• Physical Therapy Korea
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• v.26 no.1
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• pp.28-36
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• 2019

Background: Temporomandibular disorder (TMD) is characterized by pain and limited range of motion in the jaw. TMD patients generally prefer to chew on the unaffected or less-affected side, and this tendency often results in asymmetries in masseter muscle thickness and range of mandibular motion. Objects: The purpose of this study was to compare the asymmetries in masseter muscle thickness and range of mandibular motion in subjects with and without temporomandibular disorders. Methods: Thirty-nine subjects were divided into two groups: A TMD group ($n_1=19$) and a control group ($n_2=20$). The jaw opening range and laterotrusion were measured using a digital vernier caliper. The masseter muscle thickness was examined in both the resting state and the maximal clenching state using ultrasonography. The absolute asymmetry indices calculated based on the laterotrusion and masseter muscle thickness of the respective right and left sides. A two-way ANOVA and a Mann-Whitney U test were used for statistical analysis. Results: No significant different was found in the masseter muscle thickness between the TMD and control group. A significant difference was found in the absolute asymmetry indices of mandibular laterotrusion between the TMD and control groups (p<.05). Furthermore, the ranges of jaw opening were significantly different between males and females (p<.05). The absolute asymmetry index values of masseter muscle thickness at rest and during maximal clenching were also significantly different between males and females (p<.05). Conclusion: These results demonstrated that the subjects with TMD had a larger degree of asymmetry in laterotrusion than those without TMD. Therefore, a physiotherapy program needs to be designed to restore normal laterotrusion capacities for TMD subjects. These results also showed that female subjects had greater absolute asymmetry indices in masseter muscle thickness than male subjects. Therefore, more training is needed to promote bilaterally balanced chewing among women.

• Journal of Korean society of Dental Hygiene
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• v.10 no.4
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• pp.683-693
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• 2010

Objectives : The purpose of this study was to examine the relation between stress and temporomandibular disorder(TMD) of first the child. Methods : 500(the first child -250, non first child -250) high school students living in Jecheon city, form November 4th to 5th 2009, were the subjects of this questionnaire. The questionnaire was made up of three contests: sociodemographic characteristic, symptom & dysfunction of TMD and stress of high school students. The data were analyzed by chi-square test, two sample t-test and Pearson correlation. Results : Only 443(the first child -209, non first child - 234) students were evaluated due to inadequate responses. The obtain results was as follow. 1. Subjective symptom of TMD reported by 443 students were joint sound(63.5%), pain on chewing(55.1%), pain on opening the mouth(55.1%). 2. Analysis of subjective symptom of TMD showed the first child group was statistical significantly higher on joint sounds and TMJ pain than non first child group(<0.05). 3. Analysis of bad habit and dysfunction showed the first child group was statistical significantly higher on clenching of the teeth, difficulties of bite, headache than non first child group(<0.05). 4. Analysis of stress showed the first child group was statistical significantly higher on stress with parents than non first child. especially on marks and disagreement(<0.05). 5. Stress were partly related to subject symptom of TMD(<0.05, <0.01). 6. Analysis of relation stress and bad habit & dysfunction showed stress were partly related to bad habit & dysfunction(<0.05, <0.01). 7. bad habit were partly related to TMD(<0.05, <0.01). Conclusions : The first child stress and symptom of TMD were higher than non-first child, also stress and symptom of TMD was positively associated. therefore management of the first child' stress is necessary and related study is necessary in the future.

• Journal of Korean society of Dental Hygiene
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• v.17 no.4
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• pp.601-611
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• 2017

Objectives: The purpose of this study is to identify the perceived symptoms of oral and temporomandibular joint disorders in adults and to analyze the factors affecting subjective symptoms of temporomandibular joint disorders. Methods: 249 adults over 20 years old who had subjective symptoms of temporomandibular joint disorders were surveyed and analyzed. Independent t-test and ANOVA test were used to examine the relationship between oral habits and temporomandibular joint disorder according to general characteristics. $Scheff{\acute{e}}$ test was used for post-hoc analysis. Multiple regression analysis was conducted to examine the factors affecting oral habits and temporomandibular joint disorder. Results: First, the factors affecting oral and habitual behaviors were married (p<0.05) and monthly income between 1 million~1.9 million won (p<0.001), higher temporomandibular joint disorder (p<0.01) And the degree of habit was increased. Second, the factors affecting temporomandibular joint disorder were increased in occupation (p<0.05) and the degree of oral habit (p<0.01). Conclusions: In conclusion, it was confirmed that oral habit influences temporomandibular joint disorder. Especially, it is suggested that prevention and promotion of temporomandibular joint disorder are needed to recognize the removal of oral habits.

• Journal of Acupuncture Research
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• v.19 no.1
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• pp.76-83
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• 2002

Forteen cases were observed among the Temporomandibular Disorder who were outpatients at the Department of Acupuncture & Moxibustion Oriental Medical Hospital, Dae Jeon University. Objective : To improve the therapeutic rate of Temporomandibular Disorder by treatment of acupuncture, chiropractic therapy and exercise therapy. Methods : Forteen outpatients suffering from Temporomandibular Disorder were treated by acupuncture, chiropractic therapy and exercise therapy. Acupuncture therapy was taken on Waiguan(TE5,外關), Zulingi(G41, 足臨泣), Sidu(TE9, 四瀆), Yanglingquan(G34, 陽陸泉), Qiuxu(G40, 丘墟), Xiaguan(S7, 下關). Chiropractic therapy was taken, when the subluxation of outpatients's Cervical spine was observed. Results : The syndrome of TMD, that is the Pain, the movement disorder and the click sound, was disappeared by 2~3 times acupuncture, chiropractic and exercise therapy.

• Imaging Science in Dentistry
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• v.44 no.4
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• pp.293-299
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• 2014

Purpose: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). 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 T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the $X^2$ test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05). Conclusion: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

• Journal of Oral Medicine and Pain
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• v.41 no.1
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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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.113-118
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• 2008

Temporomandibular joint disorder (TMD) can induce severe pain but, its pathogenic mechanisms remain poorly understood. In this study, we analyzed proteomes of human synovial fluid in the superior joint space in the patients with TMD, which is obtained during the treatment arthrocentesis. We've got this result that one of the spots was consistently down-regulated in synovial fluid of patients with TMD from analysis of protein pattern. Its molecular weight was estimated to be 33 kDa. Synoviolin was identified in our proteomics analysis of LC/MS/MS. This protein was recently reported as one of the proteins that might affect rheumatoid arthritis (RA). Synoviolin that might be associated with RA was detected in synovial fluid of patients with TMD. We can conclude that synoviolin might be involved not only in the pathogenesis of RA but also in TMD. In result, synoviolin might be involved in the pathogenesis of TMD and can be candidates as new therapeutic targets of TMD or early detection biomarkers.

• Journal of Oral Medicine and Pain
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• v.40 no.4
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• pp.155-162
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• 2015

Purpose: The association between pain and sleep is described as a vicious cycle and psychological distress is well known as comorbid condition in the patients with pain and sleep problems. The aim of the study was to evaluate the prevalence of self-reported sleep disturbance and its relationship to clinical and psychological profiles in temporomandibular disorder (TMD) patients. Methods: The sample consisted of 123 TMD patients (90 women and 33 men), with a mean age of $39.9{\pm}15.4years$. Self-report measures of sleep quality, pain and psychological profile were conducted via the Pittsburgh Sleep Quality Index (PSQI), the Brief Pain Inventory and the Symptom Checklist-90-Revision at the initial visit. The primary diagnosis of TMD were categorized as TMD with internal derangement without pain, TMD with joint pain, TMD with muscle pain and TMD with joint-muscle combined pain. The chi-square test, independent t-test, oneway ANOVA and multiple linear regression analysis were used for statistics. Results: The patients was grouped as good sleepers (n=32, scores of 5 and lower) and poor sleepers (n=91, scores of 6 and higher) according to the recommended cutoff point of the global PSQI score (>5). TMD patients with pain showed poor sleep quality than TMD patients with internal derangement without pain. Poor sleepers had high pain interference and elevated psychological distress. Among them, pain interference and depression were significant predictors to sleep quality. Conclusions: The results suggest that sleep disturbance is a prevalent complaint in TMD patients, and sleep problems in TMD patients are associated with pain and psychological distress.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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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.

• Journal of Acupuncture Research
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• v.26 no.4
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• pp.39-47
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• 2009

Objectives : These studies are designed to make a survey of the effectiveness of oriental medicine treatment on temporomandibular disorder. Methods : The clinical study was done on 194 cases of patients with temporomandibular disorder who was treated in Ja-Seng Oriental Medicine Hospital from January 2008 to June 2008. After treatment we checked VNRS(verbal numerical rating scale) score and five-point linkert scale. Also we observed the change of symptom of click sound and trismus. Results : After the last treatment, The mean VNRS(verbal numerical rating scale) score changed 4.63 to 2.25. The click sound was disappeared of 53% patients, and the trismus was disappeared of 57% patients. And The five-point linkert scale were checked 3.78. Conclusions : It is concluded that oriental medicine treatment has on useful effect on temporomandibular disorder.