• 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.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.

• The korean journal of orthodontics
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• v.51 no.2
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• pp.126-134
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• 2021

Objective: This study aimed to evaluate the following null hypothesis: there are no differences in the morphology of the temporomandibular joint (TMJ) structures in relation to vertical and sagittal cephalometric patterns. Methods: This retrospective study was performed with 131 participants showing no TMJ symptoms. The participants were divided into Class I, II, and III groups on the basis of their sagittal cephalometric relationships and into hyperdivergent, normodivergent, and hypodivergent groups on the basis of their vertical cephalometric relationships. The following measurements were performed using cone-beam computed tomography images and compared among the groups: condylar volume, condylar size (width, length, and height), fossa size (length and height), and condyle-to-fossa joint spaces at the anterior, superior, and posterior condylar poles. Results: The null hypothesis was rejected. The Class III group showed larger values for condylar width, condylar height, and fossa height than the Class II group (p < 0.05). Condylar volume and superior joint space in the hyperdivergent group were significantly smaller than those in the other two vertical groups (p < 0.001), whereas fossa length and height were significantly larger in the hyperdivergent group than in the other groups (p < 0.01). The hypodivergent group showed a greater condylar width than the hyperdivergent group (p < 0.01). The sagittal and vertical cephalometric patterns showed statistically significant interactions for fossa length and height. Conclusions: TMJ morphology differed across diverse skeletal cephalometric patterns. The fossa length and height were affected by the interactions of the vertical and sagittal skeletal patterns.

• Journal of Oral Medicine and Pain
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• v.25 no.2
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• pp.223-228
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• 2000

The relationship between TMD and otologic symptoms such as tinnitus, vertigo and dizziness has been noted for many years. The existence of otologic symptoms in patients with TMD can be explained by the anatomic proximity and embryologic origin of the structures of the ear and the temporomandibular joint, however the pathogenesis of the symptoms is poorly understood. Serveral hypotheses have been proposed. : Eustachian tube hypothesis, the tensor tympani hypothesis, the otomandibular ligament hypothesis, excessive somatic concern hypothesis. Some investigators have reported that palpation of the deep masseter muscle, sternocleidomastoid muscle or clenching can intensify a patient's tinnitus and in that case, TMD therapy would improve their otologic symptoms. Although tinnitus and vertigo are common symptoms in the general population and also increase with increasing age, those are highly significantly associated with TMD compared with control group. This case report describes the possible mechanism and management of otologic symptoms in patient with TMD who has visited our clinic complaining asymmetric tinnitus and dull pain on her left masseter muscle.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.6
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• pp.448-456
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• 2011

Introduction: Condylar fractures are common in the maxillofacial region, comprising 29-40 percent of all mandibular fractures, accounting for about 20-62 percent). Previous studies reported that pediatric condylar fractures can cause disorders in facial growth and function, and the treatment methods have been controversial. Recently, conservative treatment has shown good results in skeletal growth and functional recovery but the conservative treatment of pediatric condylar fractures has shown unpredictable and undesirable results in some cases, such as facial asymmetry and temporomandibular joint disorder. This study examined the specific age groups and specific mandibular condylar fracture type in growing children treated conservatively in the past. Materials and Methods: Eighteen patients (10 men and 8 women) who received conservative treatment for unilateral condylar fractures in Dankook University Dental Hospital between 2000 to 2007 were followed up for a mean period of 7.2 years. Results: In the survey of 18 pediatric patients who received conservative treatment for condylar fractures, the incidence of temporomandibular dysfunction and growth disturbance was 45% and 35%, respectively. Conclusion: In all complications, the symptoms observed most frequently was mouth opening displacement of the mandible exceeding 2 mm. The other complications of functional and growth disturbance included facial asymmetry concentrated along specific condylar types. Complications including facial asymmetry and functional and growth disturbances showed an increasing tendency according to the specific fracture types. Functional and growth disturbances in the undisplaced condylar fracture type showed a lower incidence(P <0.05). Functional and growth disturbances differed according to the fracture type, which has poor relationship with articular fossa and condyle(P <0.05). Functional and growth disturbance in the cases of the high-level condylar fracture type showed a higher incidence(P <0.05). The functional and growth disturbances of the fracture types were similar in the fragment-contact and non-contact groups(P >0.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.1
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• pp.52-56
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• 2015

Clinical features of masticator-space abscess (MSA) are very similar to those of parotitis or temporomandibular disorder (TMD), making early differential diagnosis difficult. Local causes of MSA include nerve block anesthesia, infection after tooth extraction, and trauma to the temporomandibular joint (TMJ); the systemic cause is immunodeficiency. Odontogenic causes account for most etiologies, but there are also unusual causes of MSA. A 66-year-old male patient visited the emergency room (ER) presenting with left-side TMJ pain three days after receiving an acupressure massage. He was tentatively diagnosed with conventional post-trauma TMD and discharged with medication. However, the patient returned to the ER with increased pain. At this time, his TMD diagnosis was confirmed. He made a third visit to the ER during which facial computed tomographic (CT) images were taken. CT readings identified an abscess or hematoma in the left masticator space. After hospitalizing the patient, needle aspiration confirmed pus in the infratemporal and temporal fossa. Antibiotics were administered, and the abscess was drained through an incision made by the attending physician. The patient's symptoms decreased, and he was discharged.

• Journal of Oral Medicine and Pain
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• v.48 no.1
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• pp.31-36
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• 2023

This report presents the case of a 14-year-old male with rheumatoid arthritis (RA) in both temporomandibular joints (TMJs), in whom a bone scan and laboratory tests were used to confirm the diagnosis. The patient visited the Department of Orofacial Pain and Oral Medicine at the affiliation hospital with a complaint of a 1-year history of bilateral TMJ pain and sound. Clinical examination revealed bilateral TMJ and masseter muscle pain during mouth opening and palpation. Radiological examination revealed no significant morphological changes in either TMJ. The patient was prescribed medications at the first visit to address the pain, inflammation, and stiffness. A bone scan and laboratory tests were planned/scheduled for differential diagnosis between simple arthralgia and osteoarthritis. The bone scan revealed increased radiotracer uptake in both TMJs. The laboratory tests revealed a RA factor of 82.4 IU/mL, which is more than four times the normal range. The final diagnoses were bilateral TMJ early rheumatoid arthritis (ERA) and juvenile idiopathic arthritis. We created a stabilization splint and referred the patient to the Department of Rheumatology for further evaluation of the ERA. After fitting of the stabilization splint and giving instructions regarding its use, the patient has been receiving monthly follow-up checks for symptoms and undergoes follow-up blood tests every 3 months. About 14 months after the initial visit, the pain had significantly decreased from a Visual Analog Scale score of 5 to 1, and the RA factor decreased to 66.6 IU/mL. A regular follow-up check will continue until the end of growth.

• Journal of dental hygiene science
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• v.11 no.3
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• pp.285-292
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• 2011

The purpose of this study was to analyze and investigate temporomandibular disorders(TMD) and dental clinic outpatients by food intake ability to improve the quality of life. A survey of questionnaires with 208 subjects visiting a dental clinics located in Daejeon city from January to September in 2010 was performed. Analysis were performed with survey results, in which a symptoms of TMD, parafunctional habits and abnormal functions, food intake ability : 1. The main symptoms of TMD showed pain on TMJ(45.7%), pain on joint sound(45.2%), pain during chewing(41.3%), pain during mouth opening(38.0%), pain during non chewing(19.7%) and pain on joint dislocation(13.0%) in turn. 2. The symptoms of TMD by gender showed joint dislocation of 18.0% for male and 8.3% for female(p=0.038); pain on chewing of 49.0% for male and 34.3% for female(p=0.031), which were statistically significant. 3. The parafunctional habits and abnormal functions by gender showed clenching habit of 35.0% for male and 22.0% for female; bruxism of 21.0% for male and 9.3% for female, which were statistically significant. 4. The symptoms of TMD by age showed 52.8% of 27.8% for often and 25.0% for sometimes of 21-30 age in pain on TMJ, which were statistically significant(p=0.001). 5. The parafunctional habits and abnormal functions by age showed over 31 age of 48.3%, which were statistically significant(p=0.003). 6. The food intake ability by symptoms of TMD showed no joint sound(p=0.000), no pain on chewing(p=0.000) and without pain on TMJ(p=0.000), which were statistically significant. 7. The food intake ability by parafunctional habits and abnormal functions showed no clenching habit(p=0.000), no bruxism(p=0.000) and no headache, which were statistically significant. 8. The distribution type of operation by symptoms of TMD showed 30.8% of rest, 24.0% of physical medicine and 16.4% of pharmacotherapy. The pain on chewing showed 36.0% of pharmacotherapy; 52.4% of pain on TMJ for often and 40.5% for sometimes, in which pharmacotherapy and physical medicine were statistically significant(p=0.000). These results showed that management run parallel with survey for multiple factors in TMD we consider aspect of physical, social, physiology to enhance quality of life to increase food intake, construction of program for treatment and prevention because the individual differences need to be multifaceted, further research is suggested to continue.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.2
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• pp.308-315
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• 1996

Osteoarthritis is a noninflammatory degenerative disease affecting the articular surfaces and is accompanied by remodeling of the underlying bone. The sympotms of osteoarthritis of the temporomandibular joint are pain in the joint and muscles of mastication, limitation. Osteoarthritis is generally accepted that several factors can contribute to the trauma, aging process, internal derangement and MPDS. Radiographic features of the osteoarthritis are seen flattening of joint, sclerosis on flattened area and osteophyte or anterior lipping. In the past, osteoarthritis was considered to self-limiting disease. Currently, synovial chondromembrane is part of the process of osteoarthritis secondary to trauma. Synovial chondromatosis is an uncommon disease of cartilaginous transformation of synovial membrane with formation of loose bodies within the joint space. The pathogenesis is more an active metaplastic than a neoplastic process. The cause of synovial chondromatosis is unknown. Although trauma and inflammation have all been cited as possible factors in tis pathogenesis. The clinical sign and symptoms are unilateral swelling of the joint region, pain in the joint area and crepitus seem to be the most reliable signs and symptoms. Radiographic evidence of loose bodies may or may not be present. This is a case report of 66 year old female with synovial chondromatosis, that is advanced disease of the osteoarthrits. We treated patient with surgical excision of lose bodies, diskectomy and synovectomy. The defected articular fossa area was reconstructed with temporalis fascia flap. The result was satisfactory.

• Journal of Oral Medicine and Pain
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• v.35 no.1
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• pp.83-91
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• 2010

Objectives: This study aimed to assess the characteristics of temporomandibular disorder (TMD) symptoms and to determine the correspondence between TMD symptoms and clinical examination findings. Material and methods: A total of 218 patients (143 females and 75 males; age=$31.3{\pm}14.0$) were enrolled in this study who completed a questionnaire and underwent a clinical examination and radiographic assessment. Patients were asked about all the symptoms and complaints, including onset or duration, and locations of the symptoms. Clinical examination included amounts of mouth opening, palpable temporomandibular joint (TMJ) sounds, and tenderness to palpation of the TMJ and all masticatory muscles. Tenderness scores obtained from palpation of the masticatory system were summated to define the variables for further analysis. Results: Pain was the most frequently reported symptom (78.9%), followed by joint sounds (45.4%), and limitation in mouth opening (17.0%). Jaw pain comprised 91.9% of pain complaints. The subjective intensity of jaw pain was low to medium in most patients (93.7%), but it was poorly correlated with the sum of tenderness scores of the TMJ and masticatory muscles (Kendall tau = 0.084). In contrast, the side in which pain was reported by patients was well associated with the clinical examination results (pain of the right side, p < 0.001, and left side, p < 0.001). There was moderate agreement in TMJ sounds between the side identified by patients as symptomatic and clinical examination findings (kappa = 0.482). Finally, patients who complained of restricted mouth opening showed about a 10 mm less opening in all three measurements, compared to other patients (p < 0.001). Conclusion: The most frequent symptoms reported by TMD patients were jaw pain, TMJ sounds, and mouth opening limitation. The side of jaw pain, the side of TMJ sounds, and the presence of opening limitation were highly concordant between symptom reports and examination findings.