• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.39-51
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• 2011

The aims of this study were to investigate whether the facial skeletal patterns previously reported to be related to temporomandibular disorder (TMD) in other studies could be consistently observed in the TMD patients diagnosed according to Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) Axis I and evaluate its usability in the orthodontic clinics to examine the patients with TMD related symptoms. The clinical records and radiographs of female patients who visited the TMD and Orofacial Pain Clinic of Seoul National University Dental Hospital and were diagnosed as TMD were consecutively filed for this study. Patients were clinically examined and diagnosed according to the revised diagnostic algorithms of RDC/TMD Axis I and the lateral cephalogram, panoramic orthopantomogram, temporomandibular joint (TMJ) orthopantomogram, and transcranial radiograph of each patient were taken and digitalized. The data of patients who were under 18 years of age or had any systemic disease, trauma history involving the TMJ, or skeletal deformity at the time of the first examination were excluded. The remaining data of 96 female patients were finally analyzed. The obtained results were as follows: 1. There are no significant differences of cephalometric measurements between RDC I (muscle disorders) diagnostic groups. 2. Only the articular angle of the RDC group IIc (disk displacement without reduction without limited opening) patients was larger than patients of the no diagnosis of RDC II group (disk displacement). 3. Larger articular angle and smaller facial height ratio were observed in RDC IIIc group (osteoarthrosis) compared to IIIa group (arthralgia). Larger articular angle, larger Bjork sum, smaller posterior facial height, and smaller facial height ratio were observed in RDC group IIIc compared to no diagnosis of RDC III group (arthralgia, arthritis, and arthrosis). 4. According to the results of cephalometric analysis in simplified RDC groups, smaller overjet was observed in muscle disorders (MD) group. Facial height ratio and IMPA were smaller and articular angle was larger in disk displacements (DD) group than in no diagnosis of DD group. In arthrosis (AR) group, posterior facial height, and facial height ratio were smaller, and articular angle, gonial angle, facial convexity, FMA, Bjork sum, and ANB were larger than in no diagnosis of AR group. In joint pain (JP) group, only posterior facial height was smaller than no diagnosis of JP group. In conclusion, Facial morphologic patterns showing posterior-rotated mandible and lower posterior facial height is related to RDC group II and III diagnosis of the TMJ in female TMD patients. RDC/TMD Axis I diagnosis can provide a good clinical diagnostic tool for the standardized examination of the TMJ in orthodontic clinics.

• Journal of Oral Medicine and Pain
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• v.33 no.4
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• pp.323-338
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• 2008

Objectives: The aim of this study was to analyze the reliability of the Korean language version of the Research Diagnostic Criteria for Temporomandibular Disorders(RDC/TMD) axis II questionnaire among TMD patients. Methods: The Korean version of the RDC/TMD questionnaire was distributed to 154 TMD patients(31 men, 123 women) who visited Seoul National University Dental Hospital. The test-retest reliability was also assessed among the same subjects with a one- or two-week time interval. The subjects did not receive any form of therapy until the retest administration was completed. Results: The internal consistency reliability of pain intensity, disability score, jaw disability, and psychosocial status were 0.92, 0.94, 0.68, and 0.94, respectively using the Cronbach's alpha coefficient of the 1st test. Test-retest reliability coefficients of each items of the questionnaire ranged from 0.40 to 0.94 assessed with kappa value, and the intra-class correlation coefficient(ICC) for each subscale ranged from 0.81 to 0.93. Test-retest reliability coefficient of the graded chronic pain(GCP) scale was 0.63. Conclusions: The Korean language version of RDC/TMD axis II questionnaire demonstrated good reliability. It can be used as a valuable instrument for the analyses of the psychosocial aspects of the TMD patients in Korea.

• Journal of Korean Dental Science
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• v.1 no.1
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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.

• Journal of Oral Medicine and Pain
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• v.39 no.3
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• pp.100-106
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• 2014

Purpose: This study was performed to investigate the relationship between temporomandibular disorders (TMDs) and the asymmetry of the mandibular height. Methods: We compared 100 randomly selected TMD patients diagnosed by the research diagnostic criteria for TMD (RDC/TMD) Axis I with 100 non-TMD control subjects matched with the TMD patients in age and gender. The mandibular heights were measured on an orthopantomogram and the asymmetry index (AI) was calculated as previously described. Results: The absolute AI value of 4.37% turned out to be the least cut-off value defining asymmetry, which showed a significant difference in asymmetry incidence (p<0.01) between the TMD and control groups. The risk of TMD increased in the asymmetry group by 4.57 (odds ratio). The incidence of asymmetry was not related to age and gender in both of the TMD and control groups. When dividing the TMD group according to the RDC/TMD Axis I diagnosis, neither the incidence of muscle disorder nor disk displacement was related to the incidence of asymmetry. However, a higher incidence of asymmetry was observed in the subjects classified into the arthrosis/arthritis groups (p<0.01). Conclusions: Although it does not imply a direct cause-and-effect relationship, asymmetry resulting in more than 4.37% difference between mandibular heights may increase the risk of TMD and correlates positively to the incidence of arthritic change in the temporomandibular joint of TMD patients.

• Journal of Oral Medicine and Pain
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• v.40 no.1
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• pp.28-34
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• 2015

Purpose: The aim of this study is to assess the relationship between possible occlusal change after stabilization splint therapy and the research diagnostic criteria for temporomandibular disorders (RDC/TMD) Axis I diagnoses and lateral cephalometric variables. Methods: Clinical and radiographic records of 47 TMD patients wearing stablization splint were reviewed. The number of occluding teeth was recorded and lateral cephalogram was taken at pre-treatment and 6-month post-treatment. They were divided into two groups. The control group consists of patients with the unchanged number of occluding teeth throughout 6-month splint therapy (19 females and 4 males), and occlusal-loss group with the number of occluding teeth decreased (19 females and 5 males). The difference of RDC/TMD diagnoses and cephalometric variables were compared between two groups. Results: In the control group, RDC group I, muscle disorders, was 39.1% (9/23), group II, disc displacements, was 17.4% (4/23), group III OA, osteoarthritis/osteoarthrosis, was 73.9% (17/23), and group III pain, arthralgia, was 82.6% (19/23). In the occlusal-loss group, group I was 41.7% (10/24), group II was 41.7% (10/24), group III OA was 70.8% (17/24), and group III pain was 83.3% (20/24). The frequency of RDC groups was not different between two groups, analyzed by binomial logistic regression. Pre-treatment cephalometric variables were not different between two groups. However, articular angle, AB to mandibular plane and ODI decreased and gonial angle increased significantly in the occlusal-loss group, implying clockwise rotation of the mandible, between pre-treatment and 6-month post-treatment, while none of cephalometric variables showed any statistical difference in the control group. Conclusions: Change in the number of occluding teeth was not related to the RDC/TMD diagnoses. Cephalometric values changed only in the occlusal-loss group as a result of mandibular clockwise rotation. None of cephalometric variables before the stabilization splint therapy was statistically different between the control and occlusal loss group.

• Journal of Oral Medicine and Pain
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• v.30 no.3
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• pp.353-360
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• 2005

The aim of this study was to investigate the impact of depression, somatization, and jaw disability on graded chronic pain of TMD using Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Ninety-three patients (17 men and 76 women, mean$\pm$SD age of 30.1$\pm$12.5 years) diagnosed with TMD based on RDC/TMD axis I criteria were administered RDC/TMD axis II history questionnaire. The relationships between depression, somatization, jaw disability, and each parameters of graded chronic pain (e.g. pain intensity, pain days, disability score, disability days, graded chronic pain scale) were analyzed by multiple regression analysis. The obtained results were as follows: 1. Among 93 TMD patients, the prevalence of low disability group of graded chronic pain scale was 42.0% and high disability group of graded chronic pain scale was 51.5%. 2. Depression did not show any significant influences on pain intensity, pain days, disability score, disability days, and graded chronic pain scale. 3. Somatization showed a significant effect on pain intensity (p<0.01), disability days (p<0.01), and graded chronic pain scale (p<0.01) except for both pain days and disability score. 4. Jaw disability also showed a significant effect on pain intensity (P<0.001), disability days (p<0.01), and graded chronic pain scale (P<0.001) except for both pain days and disability score. Somatization and jaw disability may closely relate to the pain intensity and degree of disability that TMD patients perceive. Therefore, comprehensive understanding of psychological profile and improvement of functional limitation of jaw movements in the patient should be considered to obtain an excellent outcome of chronic TMD management.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.35 no.1
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• pp.63-68
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• 2022

Objectives : To get to know the effects of placental extract and laser theraphy for Temporomandibular Joint Disorder, we have tried a injection of placental extract and laser theraphy into 聽宮(SI19), 聽會(GB02) for patient with Temporomandibular Joint Disorder. Methods : In this case clinical assessment of temporomandibular joint dysfunction is assessed by the VAS score and the Korean Version of Research Diagnostic Criteria for Temporomandibular Disorders(RDC/TMD). Results : The VAS score was significantly decreased after Placental extract herbal acupuncture and laser theraphy Conclusion : Placental extract herbal acupuncture and laser theraphy effectively resolved pain for Temporomandibular Disorders.

• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.233-242
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• 2012

The purposes of this study were to compare psychological profiles, to investigate the differences in the clinical characteristics, and to compare treatment outcomes between myogenous pain and arthrogenous pain subgroups of temporomandibular disorder (TMD) based on Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD). Two hundred and fifty two patients diagnosed as TMD were divided into three groups based on the RDC/TMD axis I diagnostic guidelines; myogenous pain group, arthrogenous pain group, and mixed pain (both myogenous pain and arthrogenous pain) group. RDC/TMD history questionnaire was administered to each patient and depression, somatization, jaw disability, pain intensity, disability days, and graded chronic pain scale were analyzed. Bruxism, clenching, insomnia, headache, and unilateral chewing were assessed in a standardized TMD dysfunction questionnaire and the duration of onset, chronicity of pain, treatment period, the effectiveness of the treatment, and improvement of symptoms also analyzed. Myogenous pain group had higher depression (p=0.002), and somatization scales (p<0.001) than the arthrogenous pain group. Mixed pain group showed higher pain intensity (p=0.008), disability days (p<0.001), graded chronic pain scale (p=0.005), somatization (p<0.001), and depression scores (p=0.002) than the arthrogenous pain group. Jaw disability did not show any significant differences among the three groups (p=0.058). Arthrogenous pain group reported more limitation of mouth opening than myogenous pain group (p=0.007). Duration of onset showed that the arthrogenous pain group had lowest prevalence of chronicity among three groups (p=0.002). Mixed pain group patients showed lowest symptom improvements among three groups (p=0.007). Multiple linear regression analysis results showed that the treatment effectiveness was significantly associated with somatization score (${\beta}$=-0.251, p=0.03).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.187-195
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• 2008

Purpose: This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. Subjects and Methods: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade $0{\sim}IV$), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. Results: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45% of group 1, 47% of group 2, 8% of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57% (n=23) and group 1 was 35%, group 3 was 8%, while group 1 was occupied 75% in elderly-patients (over 40-year old, n=28) in present study (group 2: 21%, group 3: 4%). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in 'normal', and in Group 3 it appeared to have larger proportion of 'moderate' & 'severe' than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of 'severe' in patients with MPDS. In graded pain score, more than half (58%) of subjects were included in grade 0 and low disability (Grade I and II), and 27% were revealed high disability (grade III, IV).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.5.1-5.5
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• 2016

Background: This study clinically evaluated the effect of botulinum toxin type A (BTX-A) in the temporomandibular disorder (TMD) treatment using Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Methods: A total of 21 TMD patients were recruited to be treated with BTX-A injections on the bilateral masseter and temporalis muscles and were followed up by an oral and maxillofacial surgeon highly experienced in the TMD treatment. For each patient, diagnostic data gathering were conducted according to the RDC/TMD. Characteristic pain intensity, disability points, chronic pain grade, depression index, and grade of nonspecific physical symptoms were evaluated. Wilcoxon signed-rank test was applied for statistical analysis. Results: The results showed that more than half of the participants (85.7 %) had parafunctional oral habits such as bruxism or clenching. In comparison between pre- and post-treatment results, graded pain score, characteristic pain intensity, disability points, chronic pain grade, and grade of nonspecific physical symptoms showed statistically significant differences after the BTX-A injection therapy (p < 0.05). Most patients experienced collective decrease in clinical manifestations of TMD including pain relief and improved masticatory functions after the treatment. Conclusions: Within the limitation of our study, BTX-A injections in masticatory musculatures of TMD patients could be considered as a useful option for controlling complex TMD and helping its associated symptoms.