• Journal of Oral Medicine and Pain
• /
• v.38 no.4
• /
• pp.325-331
• /
• 2013

Botulinum neurotoxin(BoNT) is a protease exotoxin produced from Clostridium botulinum. It works by blocking the release of acetylcholine from cholinergic nerve endings causing inactivity of muscles or glands. Recently, the therapeutic use of BoNT have expanded to include a wide range of medical and dental conditions. Botulinum neurotoxin type A(BoNT/A) is used off-label in the orofacial region to treat primary and secondary masticatory and facial muscle spasm, severe bruxism, facial tics, orofacial dyskinesias, dystonias, and hypertrophy of the masticatory muscles. Local hematoma, infection, and persistent pain in the injection site are the site-of-injection side effects. Medication-related side effects are adjacent muscle weakness, slurred speech, an alteration in the character of the saliva, and severe headaches. In most cases, these complications are not persistent and bothersome. We reported a case report of a patient who had transient anterior open bite after BoNT/A injection on masseter muscles to treat the refractory myofascial pain.

• Journal of Korea Entertainment Industry Association
• /
• v.13 no.7
• /
• pp.461-468
• /
• 2019

The purpose of this study was to investigate effect of upper cervical stabilization exercise on Temporomandibular Disorder(TMD) and pressure pain threshold. 36 subjects were divided into two groups: upper cervical stabilization exercise group(UCSEG) and control on three times a week for a total of four weeks. The upper cervical stabilization group showed more significant effect than the control group (p <.01, 95% CI: 8.074, 16.899). (p <.01, 95% CI: .826, 3.243). In the change of pressure pain threshold, the upper cervical stabilization group showed significant improvement in both the masticatory muscle(p <.01, 95% CI: .251, 1.382) and masticatory muscle(p <.01, 95% CI: .462, 1.826).The results of this study showed that the upper cervical stabilization exercise was effective that TMD. It will be able to provide more effective interventions for patients suffering from TMD, and to suggest new approaches for TMD patients.

• Journal of Oral Medicine and Pain
• /
• v.22 no.1
• /
• pp.183-192
• /
• 1997

Pressure pain thresholds are routinely used in orofacial pain research to evaluate the response of deep orofacial tissues to mechanical stimulation. Like other psychophysical measurements, however, this technique must stimulate cutaneous tissues before stimulating deeper tissues. This study aimed at evaluating the influence of the cutaneous hypoesthesia on the pressure pain threshold in 30 healthy volunteers. PPTs were determined with electric pressure algometry over masseter, temporalis anterior, sternocleidomastoid, and trapezius muscle before and after skin hypoesthesia. A local anesthetic cream and a control cream were applied following a placebo-controlled double-blind design and PPTs were reassessed. Two examiners measured PPTs two times on each muscles, randomly. And the EMG activity of all muscles were measured to evaluate the relationship with PPTs. The collected data were processed by SAS/STAT program. The obtained results were as follows : 1. There were a tendency to increase PPTs after than before cutaneous hypoesthesia, but, there were no significant difference statistically. 2. PPTs were consistently higher in anterior temporalis than in masseter muscle. 3. In all occasions, PPTs were higher in males than in females(p<0.001). 4. A statistically significant correlation was obtained from values of intra-examiners and inter-examiners in all measured muscles. 5. A significantly positive correlation was not found between PPT and functional EMG activity.

• Journal of Oral Medicine and Pain
• /
• v.10 no.1
• /
• pp.113-124
• /
• 1985

In order to observe the effect of mandibular orthopedic repositioning appliance (MORA) on body strength, the author measured back muscle strength with Digital Back Muscle DYNAMOMETER (TAKEI KIKI KOGYO Co., Tokyo, Japan) before MORA, 15 days after and 30 days after MORA in 12 men and then analysed them statistically. The subjects were weight-lifting athletes of Seoul Athletic High School without dysfunction of masticatory system. MORA was fabricated at 1.0-1.5rnm isotonically closed position (Myocentric Occlusion Position) from mandibular rest position (Myocentric Rest Position) using Myo-monitor (MyoTronics Research Inc., Seattle, Washington, USA) and-SVT C-II (Tokyo Shizaisha Inc., Tokyo, Japan). The results were as follows : 1. The mean of back muscle strength before MORA was 150 kg, that of 15 days after MORA was 165 kg (4.43% increase than before), and that of 30 days was 175 kg (10.76% increase than before). 2. There was a significant difference among back muscle strength before MORA, 15 days after and 30 days after MORA (P<0.01: repeated measures one-way ANOVA). 3. According to the result of determining mandibular position for MORA fabrication, mandibular rest position after relaxation with Myo-monitor was 3.2mm lower, 1.0mm posterior, and 0.5 mm left from centric occlusion. And the mean of the amount of lateral deviation was 0.7 mm.

• Journal of Oral Medicine and Pain
• /
• v.17 no.1
• /
• pp.61-71
• /
• 1992

52 Dental students without masticatory problems were selected for this study. They were trained on several mandibular position and mandibular movement exercise, that is, rest position, light bite, tapping, hinge opening, habitual opening, opening limitation, stretch exercise, resistance exercise and clenching. The objectives of this study was to investigate the effects of mandibular movement exercise, especially stretch and resistance, on the experimentally guided limited mouth opening. Muscle activity of the anterior temporalis and the masseter on above mentioned position or exercise were recorded with bioelectric processor EM2(Myotronics, U.S.A.) and the data were processed with SPSS. The obtained results were as follows : 1. Activity of the muscles at rest position were decreased with mandibular movement exercise. 2. Forceful mouth opening on opening limitation increased muscle activity greatly, especially of the masseter. 3. On opening limitation, stretch or resistance exercise was very efficient for decrease of muscle activities. 4. There were no difference of muscle activity between on hinge opening and on habitual opening. Therefore, for muscle relaxation, the two movement exercise can be used interchangeably.

• Journal of Oral Medicine and Pain
• /
• v.33 no.3
• /
• pp.279-294
• /
• 2008

This study aimed to make an analysis of the occlusion in the state of muscle fatigue produced by excessive mouth opening and clenching during the dental treatment to control the dental pain and to evaluate the sensory nerve in the muscle pain state. Most of the reasons why patients visit the dental office result in pain-either conceivably the dental origin pain or the non-dental origin pain. The dental offices have many therapeutic actions to produce the masticatory muscle fatigue for the treatment. Dental treatment with long minutes of mouth opening can cause some headaches, masticatory muscle pain and mouth opening difficulties. Patients with mastication problems who visits a dental office to alleviate pain run against another unexpected pain with other aspects. This study uses T-scan II system(Tekscan Co., USA) for the evaluation on the occlusal pattern in the experimental muscle fatigue after clenching, opening the mouth excessively and chewing gum. The occlusal contact pattern is analyzed by the contact timing, namely first, intercuspal, maximum and end point of contact. This inspection was performed at frequencies of 2000Hz, 250 Hz and 5 Hz before and after each experimental muscle pain was produced to 24 subjects who had normal occlusion without the orthodontic treatment or a wide range of the prosthesis by using $neurometer^{\circledR}$ CPT/C(Neurotron, Inc. Baltimore, Maryland, USA). The measuring sites were mandibular nerve experimental muscle fatigue respectively. This study could obtain the following results after the assessment of occlusion and sensory nerve of the experimental muscle fatigue. 1. There were the fastest expression after the excessive mouth opening in muscle fatigue and after tooth clenching in muscle pain. In the visual analog scale that records the subjective level, there was the highest scale after the clenching in the muscle fatigue in jumping off the point of pain. 2. Tooth contact time, contact force, relative contact force on the point of the first contact had no difference, and there were decreases in the contact force after the excessive mouth opening on intercuspal position point, after the excessive mouth opening and the gum chewing on the point of the maximum, and in the contact time after all the experimental muscle fatigue state on the point of the end contact. 3. There was no statistic significance in the current perception threshold before and after the experimental muscle fatigue. 4. There was no significant difference in the contact number, the maximal contact number on the point of the first contact, and the contact number after the mouth opening and gum chewing on the point of the intercuspal position and the contact number after the experimental muscle fatigue on the maximum point, and showed significant decreases. In conclusion, it was found that the occlusal pattern can cause the changes on the case of the clinical muscle weakness by intra-external oral events. It was important that the sedulous attention to details is required during dental treatment in case of excessive mouth opening, mastication and clenching.

• Journal of Oral Medicine and Pain
• /
• v.40 no.3
• /
• pp.130-134
• /
• 2015

$Sj{\ddot{o}}gren's$ syndrome (SS) is an autoimmune disease characterized by an autoimmune exocrinopathy involving mainly salivary and lacrimal glands. Apart from manifestations due to involvement of exocrine glands, patients with SS can present with muscular and neurological manifestations. Here, we report a rare case of a 59-year-old woman with primary SS, who presented with severe general toothache and masticatory muscle myalgia successfully treated with clonazepam. Although it was not certain that these symptoms could be originated from focal muscle dystonia or neurological changes that are associated with primary SS, our case suggested that comprehensive evaluation including neuromuscular examinations in the oral and maxillofacial area is needed in patients with SS.

• Journal of Oral Medicine and Pain
• /
• v.42 no.3
• /
• pp.53-61
• /
• 2017

Myogenous temporomandibular disorder is a collective term for pathologic conditions of the masticatory muscles, mainly characterized by pain and dysfunction associated with various pathophysiological processes. Among the subtypes of myogenous temporomandibular disorder, myofascial pain is one of the most common muscle disorders, characterized by the presence of trigger points (TrPs). Various modalities, such as ultrasound, manipulative therapy, spray-and-stretch technique, transcutaneous electrical nerve stimulation, injection/dry needling, and low-level laser therapy are used to inactivate TrPs. Needling/injection on the TrPs is one of the most common treatments for myofascial pain. Despite the evidence, there is continued controversy over defining the biological and clinical characteristics of TrPs and the efficacy of injection/dry needling. This review discusses the current concept of injection/needling to relieve TrPs.

• Journal of Oral Medicine and Pain
• /
• v.13 no.1
• /
• pp.23-33
• /
• 1988

The purpose of this study was to standardized and classify the coordination pattern among the chewing side and non-chewing side masseter and anterior muscles, in terms of EMG values on lateral excursion, clenching, and mastication in presence of the non-chewing side. In this study, 25 subjects were selected for experiment of lateral excursion, clenching and mastication and EMG value of the masseter and anterior temporal muscle on both sides were recored 2 times respectively. The bioelectric processor model EM2(Myo-tonic research, INC. U.S.A.) with the surface electrodes were used to record the EMG activity during all experimental procedures. The results were as follows : 1. During lateral excursion on intereference of non-chewing side, the EMG values of the temporal muscle were significantly more prominent than those of the temporal muscle on the non-chewing side. The EMG values of non-chewing side were significantly more prominent than those of chewing side on the both side masseter muscle and those of chewing side were significantly more prominent than those of non-chewing side on the both side temporal muscle. 2. During clenching on the occlusal interferance, the EMG values of non-chewing side masseter muscle were most prominent. 3. During mastication on the occlusal interferance, the EMG values of the chewing side temporal muscle were most prominent and those of non-chewing side temporal muscle were the lowest. 4. The EMG values of temporal muscle of non-chewing side on interferance were significantly more prominent than those of canine guidance during lateral excursion. 5. During clenching on the occlusal interferance, the EMG values of the masseter and the temporal muscles of the non-chewing side were significantly more prominent than canine guidance, but those of chewing side temporal muscle on canine guidance were significantly more prominent than those of interferance. 6. During mastication on canine guidance, the EMG Values of the temporal muscle on the chewing side, the masseter muscle on the chewing side and the temporal muscle on the non-chewing side were more prominent than those of interferance, but temporal muscle of non-chewing side was not different between canine guidance and occlusal interferance on non-chewing side.

• PNF and Movement
• /
• v.20 no.3
• /
• pp.451-459
• /
• 2022

Purpose: Temporomandibular disorder (TMD) is a common musculoskeletal problem that causes pain in and disability of masticatory muscles, the temporo-mandibular joint (TMJ), and related structures. The purpose of this study was to compare pressure pain thresholds (PPTs) of masticatory muscles, cervical ranges of motion (ROM), and pelvic mobility during gait of subjects with or without TMD. Methods: In this study, pain thresholds and changes in the mobility of the cervical vertebrae and pelvis were measured in 25 patients with TMD and 25 healthy controls. Using a pressure algometer, the pressure pain thresholds (PPTs) of the masseter and temporalis muscles were measured in both groups. A gyroscope sensor with a mobile application was used to determine cervical ROM in the frontal and sagittal planes. A 3D-motion analysis system was used to evaluate pelvic mobility in the sagittal, frontal, and transverse planes during gait. Results: The TMD group showed significantly decreased PPTs of masseter and temporalis muscles compared with the control group (p < 0.05). Cervical ROM in flexion, extension, and lateral bending were significantly decreased in the TMD group compared with the control group (p < 0.05). In addition, antero-posterior pelvic tilt was significantly decreased in the TMD group (p < 0.05). Conclusion: The results of the current study suggest that there are close anatomical and functional relationships between TMD and muscle chains related to the cervical spine and pelvis. Therefore, more comprehensive body posture assessments, especially of painful areas, should be undertaken when studying TMD patients.