Clinical Characteristics and Polysomnographic Features of Patients Visited a Snoring and Sleep Apnea Clinic of Dental Hospital in Korea

김지락,정진우 대한안면통증∙구강내과학회 2017 Journal of Oral Medicine and Pain Vol.42 No.1

Purpose: The aims of this study were to evaluate the clinical characteristics and polysomnographicresults of patients visited the Seoul National University Dental Hospital (SNUDH) andto suggest guidelines for the management of sleep disordered-breathing patients in a dentalclinic. Methods: Five hundred sixty-two patients who visited the Snoring and Sleep Apnea Clinic ofSNUDH were evaluated for clinical characteristics including associated comorbidities, age, gender,body mass index (BMI), neck circumference, and daytime sleepiness and among them 217patients were performed nocturnal polysomnography for evaluating respiratory disturbance index,apnea-hypopnea index (AHI), oxygen saturation levels, and sleep stages. The associationsamong clinical characteristics, sleep parameters, and positional and rapid eye movement (REM)dependencies of the patients were analyzed. Results: The most common co-morbidities of the patients were cardiovascular (30.2%), endocrine(10.8%), and respiratory diseases (7.9%). Age (β=0.394), total AHI (β=0.223), and lowestO2 saturation levels (β=0.205) were significantly associated with the number of co-morbiditiesin patients with obstructive sleep apnea (OSA). Mean O2 saturation was not significantly associatedwith number of co-morbidities. Non-positional OSA patients had higher BMI, longerneck circumferences, more severe AHI values, and lower mean and lowest O2 saturation levelscompared to positional OSA patients. Not-REM-related patients were older and had more severeAHI values compared to REM-related patients. Not-REM-related patients have longer durationof stage I sleep and shorter stage II, III, and REM sleep than REM-related patients. Therewere no significant differences in each sleep stage between positional and non-positional patients. Neck circumference, positional dependency, REM dependency, and percentage of supineposition were significantly associated with severity of OSA. Conclusions: Age, total AHI, and lowest O2 saturation level were significantly associated withthe number of co-morbidities in patients with OSA. Neck circumference, positional dependency,REM dependency, and percentage of supine position were significantly associated with severityof OSA.

턱관절 골관절염의 치료

김지락 대한치과의사협회 2023 대한치과의사협회지 Vol.61 No.5

Osteoarthritis (OA) is common disease that can lead to severe pain and dysfunction in any joint, including the temporomandibular joint (TMJ). The treatment strategy for TMJ OA aims at reducing pain, preventing the progression of condylar bone destruction, and restoring joint function. Conservative therapy including nonsteroidal anti-inflammatory drugs, occlusal splint, and physical therapy, and arthrocentesis are the most common treatments for TMJ OA. These therapies are effective in most cases in relieving the signs and symptoms.

구강 내 장치를 활용한 코골이 및 수면무호흡증의 치료

김지락(Ji Rak Kim) 대한치과의사협회 2019 대한치과의사협회지 Vol.57 No.5

Sleep-disordered breathing (SDB) is defined as a disturbed breathing during sleep caused by repetitive upper airway collapse. Complete collapse causes a cessation of breathing, known as obstructive sleep apnea (OSA) and snoring can arise from partial collapse. Undiagnosed and untreated OSA means recurrent intermittent hypoxemia and leads to a variety of cardiovascular disorders, disturbed neurocognition, and excessive daytime sleepiness. Various behavioral modalities have been suggested for treating snoring and sleep apnea including changing the sleep position, avoiding alcohol, and weight loss. Until now continuous positive airway pressure (CPAP) therapy is one of effective treatment for patients with OSA, but its discomfort causes less tolerance and compliance. Therefore, clinical effectiveness and convenience for oral appliance have emerged and the role of dentists has become more important in the management of OSA.

Standardized Protocols for Measuring Volatile Sulfur Compounds: Scientific Foundations and Methodologies

김지윤,김지락,변진석,정재광 대한안면통증∙구강내과학회 2024 Journal of Oral Medicine and Pain Vol.49 No.1

Halitosis is defined as a nasty odor emanating through the mouth and is primarily related to the enhanced concentration of volatile sulfur compounds (VSCs). VSC measurements have been commonly used for experimental comparison and clinical diagnosis. As quantitative methods for comparative analyses of oral malodor, gas chromatography devices have been most commonly used to quickly and easily determine the concentration of several gas components of VSCs, which are agents primarily responsible for halitosis. The concentrations of VSCs fluctuate dynamically depending on contributing factors, including various oral/systemic conditions, intake of medicine and food/drink, oral hygiene, and even routine daily activities. Therefore, the exact analysis of VSCs requires the appropriate standardization of not only exact measurement techniques but also participant conditioning with scientific considerations. Thus, this paper describes the experimental standardizations commonly recommended in previous literature and their scientific background.

수면과 치의학

최재갑,김지락 대한수면의학회 2022 수면·정신생리 Vol.29 No.1

Dental sleep medicine is an up-and-coming discipline of dentistry, more specifically an offshoot of oral medicine. It traditionally focuses on sleep-related breathing disorders, such as snoring and bstructive sleep apnea. However, everyday practice shows that also other sleep disorders touch on dentistry, including orofacial pain, xerostomia, and bruxism. Therefore, a new definition has been formulated for dental sleep medicine as following; ‘Dental sleep medicine is the discipline concerned with the study of the oral and maxillofacial causes and consequences of sleep-related problems’. It is this article’s aim to further introduce the emerging discipline of dental sleep medicine to all professionals working in sleep medicine. This article briefly describes the different dental sleep disorders with special focus on the more remarkable associations between orofacial pain and sleep. "이상에서 살펴본 바와 같이 수면과 치의학은 매우 밀접한 관계에 있으며, 치과수면의학의 관심 분야가 점차 확장되고 있음을 알 수 있다. 또한 구강안면통증, 수면이갈이, 폐쇄성 수면무호흡증의 인식과 관리에 있어서 치과의사의 역할이 더욱 확대되고 중요해지고 있음이 명백해졌다. 따라서 치과 의사들은 여러 가지 치과수면장애가 개인의 전반적인 건강 과 삶의 질에 심각한 결과를 초래할 수 있다는 점을 염두에 두고 치과수면장애의 해결을 위해서 보다 적극적인 노력을 기울일 필요가 있다고 생각한다. 이를 위해서 치과대학 교 육과정에 치과수면의학을 필수 교과목에 포함시켜야 하고, 치과수면의학에 대한 졸업 후 훈련과정과 치과수면의학 전문가 자격인정제도의 도입이 필요할 것으로 생각한다. 그러나 치과수면의학이 발전하기 위해서는 무엇보다도 치과수면의학에 접근하는 치과의사의 마음가짐이 중요하다고 본다. 즉, 코골이나 폐쇄성 수면무호흡증에 대한 구강 장치요법을 사용하려는 치과의사는 단순히 장치 제작 방법 과 사용법을 익히려고 하지 말고, 수면생리와 수면장애의 전반적인 내용을 이해하고, 수면과 관련된 구강 질병이나 장애를 진단하고 치료하는 의료인으로서의 역할을 더 중요 시 여기는 자세가 필요할 것 같다. 특히 수면은 인간생활의 모든 부분에 영향을 미치고 수면장애는 인체의 거의 모든 영역에 다양한 효과를 나타내기 때문에, 수면문제의 해결을 위해서는 다학제적 접근이 필수적이라고 할 수 있다. 따라서 치과의사로서 수면과 관련된 다른 전문가 그룹과의 협 력과 소통 능력을 갖추는 것도 중요한 일이라고 하겠다."

Visual Effect on Mechanical Pain Threshold According to Anatomical Regions

강건화,김지락,변진석,정재광 대한안면통증∙구강내과학회 2022 Journal of Oral Medicine and Pain Vol.47 No.4

Purpose: Pain perception is affected by a wide range of contributing factors, including biological, psychological, and social factors. Although the provision of visual information could have a modulatory effect on pain perception, it is unclear whether such a visual effect might vary depending on the anatomical site and stimulation type. This study aimed to analyze the modulatory effect of visual information on the perception of sharp and dull pain in the face and hand and to assess the influence of individual fear levels on modulatory visual information. Methods: A total of 68 healthy male and female volunteers were recruited for this study. Pressure and pricking pain with and without visual information were induced on the masseter and thenar muscles, and alterations in pain threshold were evaluated. The survey was conducted using the Geop-Pain Questionnaire (GPQ). Results: The pricking pain threshold of the hand was significantly elevated when viewing the stimulated hand. This result indicated that the provision of visual information could decrease sensitivity to sharp pain in the hand. However, when correlating the GPQ score with the alteration in thresholds induced by visual information, no significant correlation was observed between the GPQ score and the threshold difference induced by visual information. This finding showed that the visual effect was not significantly affected by the fear level. Conclusions: This study showed that the effect of visual information on the pain threshold could vary according to the anatomical site and stimulation type. A better understanding of such a modulatory effect on pain perception might be useful for clinicians during painful therapeutic procedures.

Clinical and Hematologic Characteristics of Temporomandibular Disorders Patients

박서은,김지락,조정환,박지운 대한안면통증∙구강내과학회 2018 Journal of Oral Medicine and Pain Vol.43 No.2

Purpose: The aim of this study was to evaluate the possibility of utilizing blood tests for thediagnosis of temporomandibular disorders (TMDs) by investigating the hematologic characteristicsof TMD patients according to the main source and level of TMD pain and analyzing theirinterrelationship. Methods: Clinical examination following the research diagnostic criteria for TMD and hematologicaland psychological evaluations were conducted in 357 TMD patients. Patients weredivided into groups according to the main source of pain (myogenous, arthrogenous, and combinedpain) and the degree of pain according to the graded chronic pain scale (GCPS). Hematologicaldifferences among the groups were statistically analyzed. Results: The C-reactive protein (CRP) level was significantly higher in the arthrogenous paingroup compared to the combined pain group (p=0.032). There was no significant differenceaccording to the GCPS classification. There were significant correlations between some of theTMD pain indices and the hematologic indices, and also between the psychological indices andthe hematologic indices. Conclusions: This study suggests the possibility of applying blood tests to the diagnosis, treatmentand prevention of TMD. Further research should be conducted focusing on the role ofCRP in TMD pain with more refined methodology and a longitudinal study design.

Gender Differences in Pressure Pain Thresholds during Sustained Jaw Muscle Contraction

김철,김지락,정진우 대한안면통증∙구강내과학회 2014 Journal of Oral Medicine and Pain Vol.39 No.4

Purpose: To determine whether a fatiguing clench significantly affects the changes in pressure pain threshold (PPT) in men compared to women. Methods: The changes of PPTs from before to after a sustained clench in 12 men and 12 women were obtained. We used a decrease in median frequencies of surface electromyography (EMG) power spectra from the start to the end of the sustained clench as evidence of fatigue. Endurance time for the clench was used as a covariate. Results: The median frequencies decreased after the clench in both the anterior temporalis and masseter muscles, did not differ with the muscle or the gender of the subjects, and none of the interaction terms were significant. The PPTs were lower for women for both muscles, were decreased after the sustained clench, but failed to show the hypothesized gender by time interaction. Conclusions: Our results show that women have lower PPTs than men, but do not respond differently than men to jaw muscle fatigue.

Botulinum Toxin Injection Therapy for Lingual Dystonia: A Case Report

배소연,김지락 대한안면통증∙구강내과학회 2022 Journal of Oral Medicine and Pain Vol.47 No.3

Lingual dystonia is an uncommon focal type of oromandibular dystonia that only affects the tongue. Although the use of several treatment modalities has been attempted to reduce involuntary tongue movements, such as anticonvulsants and anticholinergics, the results do not seem promising, and the efficacy of such treatments is unpredictable among patients. This case report describes botulinum toxin injection for a patient with lingual dystonia with favorable clinical results. Botulinum toxin injection to the muscles of the tongue could be an alternative treatment option for lingual dystonia.

Age Differences in Signs and Symptoms of Patients with Temporomandibular Disorders

조정환,박지운,김지락,서형덕,장지희,정진우 대한안면통증∙구강내과학회 2015 Journal of Oral Medicine and Pain Vol.40 No.2

Purpose: The aims of this study were to evaluate the differences in subjective symptoms, clinicalcharacteristics, distribution according to Research Diagnostic Criteria for TemporomandibularDisorders (RDC/TMD) subgroup, psychological profile of TMD patients, and to identify theprevalence and trend according to age. Methods: A total of 1,052 patients (261 men and 791 women; mean age, 34.40±15.73 years)who visited the Orofacial Pain Clinic of the Department of Oral Medicine, Seoul National UniversityDental Hospital complaining of TMD symptoms of were evaluated. All patients werequestioned for medical history, clinical symptoms and contributing factors. Clinical examinationand patient grouping based on RDC/TMD was conducted. Radiographies were taken. TheKorean version of RDC/TMD axis II and Symptom Checklist-90-Revision (SCL-90-R) were administeredto evaluate pain-related disability level and psychological status of the patients. Results: Prevalence peaked in the 20-year-old age group. There were more women than men inall groups. The highest T-score among SCL-90-R dimensions was somatization in each group,except for teenagers who showed the highest T-score in interpersonal sensitivity. The 30-yearoldage group showed the highest distribution of high disability based on the graded chronicpain scale. Age was positively associated with pain intensity (r=0.100), number of positivemuscles on palpation (r=0.137) and negatively associated with maximum mouth opening(r=-0.168). Conclusions: Subjective symptoms and clinical characteristics of TMD patients show distincttendencies according to different age groups. Treatment should be customized and personalizedaccording to age for efficient symptom resolution and patient satisfaction.