• Physical Therapy Korea
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• v.27 no.2
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• pp.102-110
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• 2020

Background: There is an opinion that improper postures of the head and cervical spine are associated with temporomandibular joint (TMJ) disorders (TMDs). Objects: The aim of this study was to investigate the proportions among the cervical kyphotic angle, physical symptoms including the pain intensity level of the TMJ, and severity of TMD disability in patients diagnosed with TMD. Methods: Sixty-two subjects participated in the study. The evaluation tools included measurements of the cervical kyphotic angle based on the Ishihara index, pressure pain threshold (PPT) on the TMJ, maximal mouth opening (MMO) without pain, current pain intensity level of the TMJ measured using the Quadruple Visual Analogue Scale (QVAS), Korean TMD (KTMD) disability index, KTMD Symptom Frequency/Intensity Scales (SFS/SIS), and Korean Headache Impact Test-6. Correlation analysis was conducted to investigate the correlations between the cervical kyphotic angle and parameters related to TMJ symptoms. Results: Variables that were significantly correlated with the cervical kyphotic angle were the PPT around the TMJ (r = 0.259, p < 0.05), current pain intensity level of the TMJ based on the QVAS (r = -0.601, p< 0.01), and usual pain intensity level based on the SIS (r = -0.379, p < 0.01). The level of TMD functional disability was significantly correlated with the degree of headache (r = 0.551, p < 0.01), level of PPT of the TMJ (r = -0.383, p < 0.01), pain-free MMO (r = -0.515, p < 0.01), pain intensity level of the TMJ based on the QVAS (r = 0.393, p < 0.01), TMD symptom frequency (r = 0.739, p < 0.01), usual pain intensity of the TMJ (r = 0.624, p < 0.01), and most severe pain intensity of the TMJ (r = 0.757, p < 0.01). Conclusion: There is a positive correlation between the cervical kyphotic angle and PPT and a negative correlation between the current and usual pain intensity levels of the TMJ. The cervical kyphotic angle was a predictor of the pain level, tenderness threshold, and intensity of pain in the TMJ.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.3
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• pp.183-205
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• 2021

This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with "general HA." Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

• Korean Journal of Radiology
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• v.23 no.2
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• pp.218-225
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• 2022

Objective: This study aimed to explore the feasibility of functional evaluation of the lateral pterygoid muscle (LPM) using diffusion tensor imaging (DTI) in patients with temporomandibular joint disorders (TMDs). Materials and Methods: A total of 119 patients with TMD (23 male and 96 female; mean age ± standard deviation, 41 ± 15 years; 58 bilateral and 61 unilateral involvements for a total of 177 joints) and 20 healthy volunteers (9 male and 11 female; 40 ± 13 years; 40 joints) were included in this prospective study. Based on DTI of the jaw in the resting state, the diffusion parameters, apparent diffusion coefficient (ADC), fractional anisotropy (FA), λ1, λ2, and λ3 of the superior and inferior heads of the LPM (SHLPM and IHLPM) were measured. Patients with TMD with normal disc position (ND), anterior disc displacement with reduction (ADWR), and anterior disc displacement without reduction (ADWOR) were compared. Results: Patients with TMD overall, and ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 in both the SHLPM and IHLPM than those in volunteers (p < 0.05 for all), whereas the ND subgroup only had significantly higher ADC and λ1 (p < 0.001). Meanwhile, significant differences in FA in the SHLPM and IHLPM were found between volunteers and ADWOR (p = 0.014 and p = 0.037, respectively). Among the three TMD subgroups, except for λ3 and FA in the ADWR subgroup, ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 and lower FA than those in the ND group (p < 0.050). There was no significant difference in diffusion variables between ADWR and ADWOR. In ADWOR, the osteoarthritis group had significantly higher λ3 and lower FA values in the IHLPM than those in the non-osteoarthritis group. Conclusion: DTI successfully detected functional changes in the LPM in patients with TMD. The unsynchronized diffusivity changes in the LPM in different subgroups of TMD signified the possibility of using diffusion parameters as indicators to identify the severity of LPM hyperfunction at various stages of TMD.

• Journal of Oral Medicine and Pain
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• v.31 no.4
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• pp.347-354
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• 2006

Most patients suffering from TMD appear to have unsatisfactory masticatory function and compromised values of bite force. The purposes of this study were to investigate and compare bite force between affected and unaffected sides of patients with unilateral TMD and to evaluate its relation with duration of TMD. 42 patients with unilateral TMD, from Department of Oral Medicine, Dankook University Dental Hospital, were selected for this study. The ratio of men to women was 9:33 and their mean age of $27.2{\pm}10.4$ years. The bite forces were measured over both canines (for anterior bite force) and $1^{st}$ molars (for posterior bite force) using a bite force recorder while all the subjects were asked to clench successively for 3 seconds not until pain was felt. They were compared with those measured from bilateral TMD patients(N=6, M:F=1:5, mean age: $23.0{\pm}27.3$ years). The unilateral TMD patients were divided into time groups according to duration of TMD on the basis of 1 and 6 months, respectively. Paired and unpaired t-tests were used for statistical analysis. Unilateral TMD patients in this study showed that the affected sides had significantly lower bite force than the unaffected sides(force difference of about 7-8 kgf, p<0.05) while there was no significant sides difference in the bilateral patients. Nor did bite force on the affected sides reveal significant difference between unilateral and bilateral TMD patients. With regards to TMD duration, there was significant difference between the patients with TMD < 6 months and $\geq$ 6 months (p<0.05) while no significant difference existed between < 1 month and $\geq$ 1 month. The results of this study indicated that unilateral TMD patients can exhibit more reduced bite force on the affected sides compared with that on the unaffected sides and that bite force on the unaffected sides might be deteriorated more as longer did TMD last.

• Journal of Periodontal and Implant Science
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• v.47 no.4
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• pp.211-218
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• 2017

Purpose: The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. Methods: Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. Results: The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. Conclusions: The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic long-term periodontitis without treatment should be urged to undergo a TMJ examination.

• 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 Oral Medicine and Pain
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• v.42 no.2
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• pp.29-34
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• 2017

Purpose: To evaluate aggravating factors of intermittent locking among temporomandibular joint using magnetic resonance imaging (MRI) and diagnostic criteria for temporomandibular disorder (DC/TMD) diagnosis. Methods: A retrospective analysis was conducted of 35 patients with intermittent locking history but normal intra-articular findings between September 2012 and June 2015 in Kyung Hee University Dental Hospital. A standardized DC/TMD assessment was performed on subjects with MRI findings. Clinical findings were assessed on the basis of maximum mouth opening (active & passive), self-reported habits, patients' age, gender, systemic diseases at the initial visit. First, chi square test was used to examine differences with variables and then risk factors for intermittent locking were assessed using multivariate logistic regression. Results: Self-reported bruxism was strongly associated with intermittent locking history. Conclusions: The new DC/TMD protocol is intended for use within any clinical setting and supports the full range of diagnostic activities from screening to definitive evaluation and diagnosis. Self-reported sleep bruxism has been associated with a higher likelihood of intermittent locking. Comorbidity is therefore a factor that must be assessed. It is necessary to consider the amount of contact of the teeth and the duration.

• The Journal of Korean Academy of Prosthodontics
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• v.54 no.4
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• pp.431-437
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• 2016

In cases of extensive prosthetic restoration, correction of occlusal contact is often needed, as it is the essential component for a successful restoration. If occlusal contact is given incorrectly, various symptoms of occlusal trauma can occur of which temporomandibular joint disorder (TMD) is one of them. As one of the common symptoms of TMD, patients may suffer with masticatory muscle disorder and temporomandibular joint pain. This case presents satisfactory results for the improvement of masticatory muscles and temporomandibular joint pain of a TMD patient, caused by incorrect occlusal contact of the restoration, by replacing the prosthesis after occlusion correction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.4
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• pp.270-274
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• 2010

Introduction: Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR. Material and Methods: A total of 14 patients (female 12, male 2, average age: $29.1{\pm}14.4$), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range <35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis. Results: After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was $30.2{\pm}3.5mm$ and the average MMO after treatment and follow up was $47.1{\pm}4.7mm$. The mean amount of mouth opening increment was $16.9{\pm}5.4mm$ (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001) Conclusion: The template appliance proved to be efficient for the treatment of TMD with a closed lock and painful joint due to ADDWOR.

• Journal of Oral Medicine and Pain
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• v.43 no.2
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• pp.27-33
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• 2018

Purpose: Many researchers have established a connection between sleep disturbances and the symptoms of temporomandibular disorder (TMD) in adults, but there are a few studies targeted at adolescents with TMD. The aim of this study was to analyze the sleep pattern of adolescents with TMD and to determine the effect of poor sleep quality on their clinical symptoms. Methods: The subjects were composed of 47 adolescents with TMD. The sleep pattern and preliminary information of patients were measured by self-reported questionnaires; Pittsburgh Sleep Quality Index (PSQI) and Questionnaire for TMD analysis. TMD pain was scored using the Numerical Rating Scale. The Kruskal-Wallis test, Mann-Whitney U test, Fisher's exact test and logistic regression were used for statistical analysis. Results: The poor sleeping group had statistically more females (25.00% males, 75.00% females) than the good sleeping group. As compared with that of good sleepers, sleep quality of poor sleepers was significantly worse in the items of subjective sleep quality, sleep latency, sleep duration, sleep disturbances, daytime dysfunction and global PSQI score. The sleep time of adolescents was much longer during vacation ($7.20{\pm}1.38hours$) than during school days ($6.10{\pm}1.26hours$). Poor sleep of patients was associated with the pain in the ear or in front of the ear, in the face, jaw, throat or temple and in neck or back. Adolescents with pain in those areas had significantly higher proportion of poor sleepers than adolescents with no pain in those areas. Conclusions: The high ratio of girls in poor sleeping group could reflect the greater prevalence of TMD in women than in men. Pain in peri-temporomandibular joint areas, neck or back could negatively influence sleep quality of adolescents with TMD.