• Journal of Oral Medicine and Pain
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• v.38 no.4
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• pp.339-356
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• 2013

This study was designed to evaluate the sex differences in the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into four group each from male (n=20) and female (n=20); saline injection group (n=5), lidocaine injection group (n=5), morphine 1.5 mg injection group (n=5) and morphine 3 mg injection group (n=5). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 1 hour, 24 hour, 48 hour and then it was analyzed statistically. The results were as follows : 1. The male and female were significantly different statistically morphine 3 mg group in visual analogue scale evaluation. (male: p<0.05, female: p<0.05) 2. The male and female were more significantly different statistically morphine 3 mg group than morphine 1.5 mg group in McGill pain questionnaire evaluation. (male: p<0.001, female: p<0.01) 3. The male were significantly different statistically morphine 3 mg group in pain drawing evaluation and pressure pain threshold evaluation. (PD: p<0.001, PPT: p<0.05) Therefore, it was revealed that the morphine 3 mg injection for masticatory muscle pain was effective to pain control male patients and more effect than female patients in the objective pain evaluation.

• Journal of Oral Medicine and Pain
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• v.32 no.1
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• pp.105-111
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• 2007

Correlation between occlusal contact pattern and TMD have been hypothesized and partially investigated but results are controversial and not conclusive. The purposes of this study were to compare right-to-left difference of occlusal contact pattern, through contact points, contact force and occlusal balance, in the patients with unilateral TMD and also to evaluate its change related with TMD treatment. 36 patients with unilateral TMD from Department of Oral Medicine in Dankook University Dental Hospital were selected in this study (M:F=7:29, mean age of $29.2{\pm}14.8$ years). A computerized T-Scan II system (Tekscan, INC., USA) was employed for occlusal analysis and the simultaneity and occlusal balance through the number of tooth contact and magnitude of contact force were determined before and after TMD treatment. The number of contact points and contact force was more on the unaffected side than the affected side before treatment (p=0.056 and p=0.060, respectively) while significant difference between both sides was not found after treatment. The number of contact points and contact force on the affected sides significantly increased after treatment (p=0.038 and p=0.052), but the unaffected sides exhibited no significant difference between before and after treatment. In addition, sides difference in relative contact force decreased from about 27% to about 12% after TMD treatment (p=0.001). According to the results of this study, it is likely that unilateral TMD impairs right-to-left occlusal balance and that conservative TMD treatment alleviates the imbalance, subsequently leading to more symmetrical occlusal condition with increased contact points and force.

• Journal of Oral Medicine and Pain
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• v.33 no.3
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• pp.247-256
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• 2008

The belief that stress leads to illness has a long history. A number of the orofacial disease are also closely associated with stress. Despite research in the relationship of stress and the orofacial diseases leading to statistically significant correlations, the pathology remains vague. In the present study, the expression of clusterin, a stress protein responsible for antiapoptosis and cytoprotection, under restraint stress condition was observed in the submandibular gland, one of the major salivary glands. Sprague-Dawley rats were divided into 2 groups: normal group and restraint stress group. The rats of restraint stress group were placed in the stress cages and then sacrificed at day 0, 3 and 5 day of the experiment. After that, the submandibular glands of all the rats were excised immediately. The levels of clusterin proteins and mRNA in the tissues were measured by immunohistochemistry and Northern blot analyses, respectively. The results were as follows: 1. In the immunohistochemistry, clusterin protein was detected only immediately after the application of restraint stress. 2. In the restraint stress group, at day 3 and 5, histologically apoptosis was induced with karyorrhectic and pyknotic changes. 3. By the restraint stress, acinic cells were destructed earlier than ductal cells. 4. In the Northern blot, mRNA of clusterin was expressed only immediately after the application of restraint stress. The overall results suggest that as an early response to stress, clusterin is expressed in the glands to protect the glandular cells from the stress. But if stress is so strong and prolonged that it can exceed the stress adaptability of the cells, then the cells may undergo apoptosis instead of producing clusterin. An Epidemiologic Study of Symptoms of Temporomandibular Disorders in Korean College Students.

• Journal of Oral Medicine and Pain
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• v.38 no.3
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• pp.275-289
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• 2013

This study was conducted to investigate and analyze the dental patients' awareness and understanding about TMDs. Among the total number of 243 patients who had visited the department of dentistry of Busan Paik Hospital, Inje University or Hanvit dental hospital in Ulsan metropolitan city and participated in the survey, 195 patients who filled in all parts of the questionnaire were selected as the subjects. The results were as follows. 1. The subjects who were aware of the term, "TMDs" were 17.4%. The group with total education period of 12 years and over was significantly more aware of "TMD"(82.4%, p<0.01) than the other group. The subjects who were aware of the term, "jaw joint disease" were 81.0%. 30 to 49 age group(45.6%, p<0.05) and the group with total education period of 12 years and over(60.1%, p<0.01) were significantly more aware of "jaw joint disease" than other groups. 2. More than half of the subjects chose "overuse of the jaws" as the concept of jaw joint disease(50.6%). 3. TV, radio(41.4%) was the most frequent source of awareness about jaw joint disease followed by family and friends(20.2%), hospitals and health professionals(18.2%), internet(15.7%) and newspapers, magazines(4.5%). Among the respondents who were aware of jaw joint disease through TV, radio, 30 to 49 age group showed significantly higher percentage(52.4%, p<0.05) than other age groups. Among the respondents who were aware of jaw joint disease through internet, 18 to 29 age group showed significantly higher percentage(61.3%, p<0.01) than other age groups. Among the respondents who were aware of jaw joint disease from hospitals and health professionals, the group with total education period of 12 years and over showed significantly higher percentage(75.0%, p<0.05) than the other group. 4. Noise during mouth opening and closing(26.9%), mouth opening difficulty(25.1%) and jaw pain(13.7%) were the most frequently responded sign and symptoms of jaw joint disease. For the causes of jaw joint disease, enjoying hard food chewing(19.5%), occlusal discrepancy(19.0%) and chewing with one side only(18.5%) were responded in sequence. TMJ surgery(28%) was the most frequently responded treatment method for jaw joint disease, followed by occlusal appliance therapy(23.9%) and physical therapy(14.6%). For preventive method of jaw joint disease, avoid eating hard food(21.1%), avoid opening mouth wide(17.0%) and simultaneous using of molar of both side when chewing food(15.4%) were chosen frequently.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.375-381
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• 2007

Occlusal stabilization appliance is one of the most common treatment option for management of temporomandibular disorders. It acts in oral cavity for several hours per day, and usually it will take at least 6 months to 2 years of total wearing periods to take a treatment goal. In the oral cavity, occlusal stabilization appliance, unintentional manner, is able to acts as a reservoir of bacteria and protect bacteria from saliva and oxygen. This condition is so favorable to many bacteria such as S. mutans and other anaerobes, usually have been reported as causative factors of dental caries, periodontal disease and oral malodor. In this study, we investigated anaerobic bacteria and S. mutans count before and after occlusal stabilization appliance use to evaluate the possible role of occlusal stabilization appliance as protector of these bacteria. Four men(average 27.5 years) wore maxillary occlusal stabilization appliance at each night(average 9 hours) for 5 days. we swabbed saliva-plaque mixed sample at 3 different site(maxillary left 2nd molar, maxillary left central incisor, mandibular left 2nd molar) before and after occlusal stabilization appliance use. Each samples were plated in (1) anaerobic blood agar medium, (2) selective S. mutans medium(MS-MUTV) and incubated in anaerobic chamber($CO^2$ 10%, $37^{\circ}C$) for 72 hours. Each bacterial colony forming unit(CFU) were counted with naked eyes. From obtained data, we can conclude as follows: 1. There was some changes about anaerobic bacteria and S. mutans count in oral cavity after occlusal stabilization appliance use. 2. The number of anaerobic bacteria was significantly increased at maxillary 2nd molar(P=0.003), maxillary central incisor(P=0.020) after occlusal stabilization appliance use compared with before. 3. Occlusal stabilization appliance use itself had indirect effect to increase the number of anaerobic bacteria at other uncovered opponent tooth site. 4. The number of S. mutans was significantly increased at maxillary 2nd molar(P=0.043), maxillary central incisor (P=0.049) after occlusal stabilization appliance use compared with before. 5. Occlusal stabilization appliance use itself had not any effect on the number of S. mutans at other uncovered opponent tooth site.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.403-411
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• 2007

This investigation was carried out to evaluate the effect of Transcutaneous Electric Nerve Stimulation (TENS) to experimentally induced masticatory muscle pain and muscular fatigue. Twenty-nine healthy volunteers (18 men and 11 women, aged $26.1{\pm}4.7$ years) without past history or present symptoms of temporomandibular disorders were participated in this study. All of the subjects were randomly assigned to experimental group and control group, after at least 3 days interval, two groups were reassigned conversely. Subjects assigned to experimental group were received TENS and others assigned to control group were received sham-TENS therapy for 45 minutes, respectively. The changes of Visual Analogue Scale (VAS), Pressure Pain Threshold (PPT), and EMG power spectrum were measured on the masseter muscle both before and after sustained fatiguing contraction in each group. The major findings of this study are as follows : 1. PPTs and median frequencies of masseter muscles were significantly decreased after sustained isometric contraction resulting in muscular fatigue. 2. In experimental group received TENS therapy, PPTs measured both before and after occurrence of experimentally induced muscular fatigue were significantly increased. 3. In experimental group received TENS therapy, the changes of PPTs during sustained isometric contraction resulting in muscular fatigue were significantly decreased. 4. In experimental group received TENS therapy, VAS measured after occurrence of experimentally induced muscular fatigue was significantly decreased. 5. Although there were not statistical significances, endurance time was increased in experimental group received TENS therapy and decreased in control group received sham-TENS therapy. 6. In experimental group received TENS therapy, the changes of median frequencies were the less decreased and the slope of median frequency shift was the more increased during endurance time than in control group, however, there were not statistical significances.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.161-174
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• 2013

This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into four group; saline injection group (n=10), lidocaine injection group (n=10), morphine 1.5 mg injection group (n=10) and morphine 3 mg injection group (n=10). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 1 hour, 24 hour, 48 hour and then it was analyzed statistically. The results were as follows : 1. The subjective pain evaluation were significantly different statistically in morphine 3 mg group after 48 hour. (VAS: p<0.01, MGQ: p<0.001, PD: p<0.05) 2. The objective pain evaluation were significantly different statistically in morphine 1.5 mg group after 1 hour. (PPT: p<0.01, PPTol: p<0.05) 3. The morphine 3 mg group were more significantly different than lidocaine group and morphine 1.5 mg group statistically in the McGill pain questionnaire evaluation. (1h: p<0.01, 24h: p<0.01, 48h: p<0.001) Therefore, it was revealed that the morphine 3 mg injection was effective to pain control for masticatory muscle pain patients within 48 hours and more effect than lidocaine injection.

• Journal of Oral Medicine and Pain
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• v.36 no.3
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• pp.187-197
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• 2011

Temporomandibular disorders(TMD) is a collective term which is embracing a number of clinical problems that involve the masticatory musculature, the TMJ and associated structures, or both. Myofascial pain, which is a kind of masticatory muscle disorder of TMD, is the sensory, motor, and autonomic symptoms caused by myofascial trigger points. There has been some controversies regarding etiologies of TMD and MFP. Especially the issue of occlusal conditions has been a critical issue for long time. Despite much efforts, the results of studies regarding occlusal conditions were contradictory. These controversies might be mostly due to various factors resulting from the complex nature of TMD, however, inaccurate and inappropriate study design, selection criteria, methodologies also play significant roles. Recently, a computerized occlusal analysis system, T-Scan II which made it possible to reveal quantifiable time data and relative force data for analyzing occlusion, was introduced. Some authorities suggested that the concept of disclusion time and prolonged disclusion time of posterior tooth and MFP are related using T-Scan II. But the previous studies which used T-SCAN II are not reliable for they did not provide accurate diagnostic criteria of MFP. Morever they did not compare with controls, and had many other problems. The purpose of this study was to evaluate the relationship between MFP and prolonged disclusion time of posterior tooth, which is one of the occlusal factors of TMD, by selecting 30 subjects as the study group through strict criteria and comparing them with 38 controls using T-SCAN II, computerized occlusal analysis system. The results, statistically analyzed, are summarized as follows: 1. Cronbach ${\alpha}$ coefficient of repeated measurements of disclusion time was 0.92. 2. There were no statistically significant differences at repeated measured disclusion time of both side between control and study group. 3. There was no statistically significant diffefence in the disclusion time between right and left side. From the results above, we can suggest that there was no relationship between MFP and disclusion time, so irreversible treatments leading to the reduction of disclusion time for treating MFP would not be appropriate. However more controlled, large scaled study, which consider various occlusal factors, and quantification of symptoms using Helkimo index would be necessary in the future.

• Journal of Oral Medicine and Pain
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• v.34 no.2
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• pp.217-225
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• 2009

As Pain is a comprehensive, biopsy chosocial phenomenon, improved understanding and successful management of pain need assessment of health-related quality of life and psychological states. The purpose of this study was to evaluate pain severity and pain-related interference to daily lives for patients with non-dental, orofacial pain(OFP) and a possible relation of OFP with psychological morbidity. Relation with such factors as gender, age, pain duration and diagnosis was also assessed. Inclusion criteria was all new patients with non-dental OFP attending the oral medicine.orofacial pain clinic of Dankook University Dental Hospital over 3 months' period, who completed the questionnaires of the Brief Pain Inventory (BPI) and Hospital Anxiety and Depression Scale (HADS). Prior to the first consultation, the patients were asked to fill out the questionnaire in the waiting room and were diagnosed through consultation and clinical examination. Total subjects were 163 with M:F ratio of 1:1.5 and mean age of 34.6${\pm}$17.7 years. Mean duration of pain was 13.3${\pm}$26.2 months and all patients were divided into; Trigeminal Neuralgia group (TN, N=8), Neuropathic Pain group (NeP, N=9), Persistent Idiopathic Facial Pain group (PIFP, N=8), and Temporomandibular Disorders group (TMD, N=138), subdivided into muscle problem (TMD-m, N=73), joint problem (TMD-j, N=24) and muscle-joint combined problem (TMD-c, N=41). OFP patients showed moderate pain severity and moderate pain-related interference. There was no gender difference in overall pain severity and interference and levels of anxiety and depression. Elderly patients aged ${\geq}$ 60 years showed higher pain severity (p<0.05). Patients with chronic pain ${\geq}$ 3 months reported more increased level of anxiety and depression than those with acute pain (p<0.05). Compared to TMD patients, patients with TN, NeP and PIFP suffered from higher level of pain and pain-related interference and reported higher level of anxiety and depression (p<0.05). Pain interference was closely correlated with their pain severity and with psychometric properties such as anxiety and depression. Pain severity was weakly correlated with levels of anxiety and depression. The results suggest a need for psychosocial assessment and support for successful management of OFP in addition to control of pain itself.