삼차신경손상의 온도역치검사에 대한 예비연구

김미은,Kim, Mee-Eun 대한안면통증구강내과학회 2012 Journal of Oral Medicine and Pain Vol.37 No.4

임플란트 수술이나 발치 같은 침습적인 치과치료로 인한 삼차신경 손상의 증가는 최근 치과계의 가장 민감한 문제의 하나로서 향후 법적인 문제로 까지 이어질 수 있다. 그러므로 신경손상에 대한 객관적이고 신뢰성 있는 평가 즉, 정량적 감각신경 검사(quantitative sensory testing)의 필요성이 강조되고 있으며, 온도역치 검사는 QST의 필수 항목으로 구강영역에서도 신뢰성이 입증되어 있다. 국내에서는 삼차신경손상과 관련한 온도역치 검사에 대한 보고가 아직 없기에, 본원에서 시행한 일부 증례의 온도역치 검사의 결과를 평가하고자 하였다. 2011년 5월부터 2012년 10월까지 단국대학교 치과대학 부속 치과병원 구강내과에 내원한 삼차신경손상이 의심되는 환자중 온도역치 검사를 시행한 18명의 환자 자료를 분석하였다. 환자들의 냉인지역치(cold detection threshold, CDT)는 이환측이 비이환측에 비해 유의하게 낮았으나 온인지역치(warm detection threshold, WDT), 냉통각역치(cold pain threshold, CPT), 열통각역치(heat pain threshold, HPT)는 통계적 차이를 보이지 않았다. 향후 더 많은 피검자를 대상으로 온도 자극과 관련하여 감각저하나 감각과민, 통각저하나 통각과민 같은 유형별 비교 연구가 필요하다. Trigeminal nerve injuries due to invasive dental procedures such as implant surgery and extraction is one of the most serious issues in dentistry and may provoke medico-legal problems. Thus, for objective and reliable assessment of nerve injury, a need of QST (quantitative sensory testing) is emphasized and thermal threshold test is an essential part of QST, reported to have acceptable reliability in the orofacial region. This pilot study aimed to evaluate thermal thresholds for limited cases of trigeminal nerve injures. The study investigated 18 clinical cases with trigeminal nerve injuries who visited Department of Oral Medicine, Dankook Univeristy Dental Hospital during the period from May 2011 to Oct 2012. Thermal thresholds was measured by Thermal Sensory Analyzer, TSA-II (Medoc, Israel). Their CDT(cold detection threshold) was significantly decreased in the affected sides compared to the unaffected sides. Other parameters such as WDT(warm detection threshold), CPT(cold pain threshold) and HPT(heat pain threshold) did not show statistical difference between the affected and unaffected sides. Further researches are required to compare thermal thresholds relative to types of nerve deficits such as thermal hyper- or hypoesthesia and hyper- or hypoalgesia for larger sample.

Effects of Oral Parafunction on the Stiffness and Elasticity in the Muscles of the Mastication and Facial Expression

김승기,김미은,김기석,Kim, Seung-Ki,Kim, Mee-Eun,Kim, Ki-Suk Korean Academy of Orofacial Pain and Oral Medicine 2008 Journal of Oral Medicine and Pain Vol.33 No.1

The purpose of this study was to evaluate the effects of oral habits on the muscles of mastication and facial expression by means of two parameters: muscle stiffness and elasticity. 10 healthy, fully-dentate male subjects in their twenties were selected for this study; all had normal Class I occlusal relationships. Muscle stiffness and elasticity were measured with a tactile sensor(Venustron, Axiom Co., JAPAN) while subjects were asked to relax and perform various parafunctional activities such unilateral clenching(biting the bite force recorder with a force of 50kg on each subject's preferred side), jaw thrusting and lip bracing. The following muscles were examined: temporalis anterior(Ta), masseter(Mm), frontalis(Fr), inferior orbicularis oculi(OOci), zygomaticus major(Zm), superior and inferior orbularis oris(OOrs and OOri) and mentalis(Mn). Paired t-test, Correlation Coefficients, ANOVA and Multiple Comparison t-tests were used for statistical analysis. Unilateral clenching was highly correlated with bilateral stiffness and elasticity of all the muscles tested. Mm was affected by all three oral habits; Ta was affected by unilateral clenching(p<0.05); Zm was affected by unilateral clenching and OOrs, OOri and Mn were most affected by lip bracing(p<0.05). This study indicates that not only the masticatory muscles but also the muscles of facial expression, mainly circumoral muscles, can be significantly influenced by parafunctional activities such as unilateral clenching and lip bracing.

Psychosocial Impact of Chronic Orofacial Pain

양동효,김미은,Yang, Dong-Hyo,Kim, Mee-Eun Korean Academy of Orofacial Pain and Oral Medicine 2009 Journal of Oral Medicine and Pain Vol.34 No.4

The aim of the study was to evaluate psychosocial impact of non-dental chronic orofacial pain (OFP) on daily living using the graded chronic pain (GCP) scale. It is also investigated the clinical profile such as demographics, event related to initiation of OFP and prior treatments for patients. During previous 6 months since September 2008, 572 patients (M:F=1:1.5, mean age=34.7 years) with non-dental OFP attended university-based specialist orofacial pain clinic (Dankook University Dental Hospital, Cheonan) to seek care although 63% of them already experienced related treatment for their OFP problem. They visited the most frequently general dental practitioner and orthopedic doctors due to their pain problem and medication was the most commonly employed modality. Most of the patients (89.2%) had TMD and the most common related event to initiation of their pain was trauma, followed by dental treatment. Almost half of the patients (46%) suffered from chronic pain(${\geq}6\;M$) and 40% of them exhibited relatively high disability due to chronic OFP. GCP pain intensity and disability days were significantly different for age and diagnosis (p<0.05) but not for gender and duration. GCP grades were affected by all the factors including gender, age, pain duration and diagnosis.(p=0.000) Female gender, elders, and long lasting pain were closely related to high disability. The patients with neuropathic Pain and mixed OFP rather than TMD were graded as being highly disabled. Conclusively, a considerable percentage of chronic OFP patients reports high pain-related disability in their daily, social and work activity, which suggest a need for psychosocial support and importance of earlier referral for appropriate diagnosis and tailored management.

Muscle Stiffness and Elasticity of Masticatory Muscles on Gum Chewing

원태희,김미은,김기석,Won, Tae-Hee,Kim, Mee-Eun,Kim, Ki-Suk Korean Academy of Orofacial Pain and Oral Medicine 2007 Journal of Oral Medicine and Pain Vol.32 No.4

Some researchers suggested that tactile sensor system would be useful in evaluating masticatory muscles of TMD patients, but there were few studies on the effects of chewing with time. The aim of this study was to investigate the change of elasticity and stiffness for masseter and temporal muscles of normal subjects before, during and after gum chewing and to obtain the baseline data for further researches on the elasticity and stiffness for masticatory muscles of TMD patients. Stiffness and elasticity of their anterior temporalis and inferior masseter muscle were measured bilaterally by a tactile sensor system. Each subject was instructed to sit on a chair for evaluation of masticatory muscles. Before operating the sensor, the thickest skin area over anterior temporalis and inferior masseter muscles were selected as the points to be pressed by a tactile sensor, and marked with a pen. While the teeth of subjects were lightly contacted, the probe of the tactile sensor was placed perpendicularly over the marked point over the skin, followed by computer-controlled movement including gently pressing straight down on the muscle for a second and retracting. All subjects were instructed to chew gum (Excellent Breath, Taiyo Co., Japan) bilaterally with a velocity of 2 times per second for 40 minutes after the first measurement had been performed for the baseline data of all subjects. The measurements had been repeated during chewing with 10 minutes of interval and continued for 40 minutes with same interval after chewing. Resultantly, the decrease of elasticity and the increase of stiffness in masticatory muscles can be seen significantly within 10 minutes after chewing and those were maintained during chewing without significant change with chewing time. The elasticity of muscles was recovered within 10 minutes after stopping chewing, but the stiffness was recovered more lately than elasticity by about 10 minutes. Based on these results, it can be concluded that elasticity and stiffness of muscles would be good indicators to evaluate the masticatory muscles objectively, when more supported by further researches.

Muscle Stiffness and Elasticity Related to Physical Therapeutic Modalities

김성환,김미은,Kim, Sung-Hwan,Kim, Mee-Eun Korean Academy of Orofacial Pain and Oral Medicine 2007 Journal of Oral Medicine and Pain Vol.32 No.3

The purpose of this study was to quantitatively assess treatment effect of physical therapy on experimentally-induced masseter muscle fatigue by two parameters of muscle stiffness and elasticity. Three physical therapeutic modalities inducing electroacupunture stimulation therapy(EAST), Microwave diathermy and low-level laser therapy(LLLT) were compared. 10 healthy volunteers with normal occlusion (mean age of $26.3{\pm}1.16$ years, M:F=1:1) were participated in this study. All subjects were asked to chew gum on the right side until they felt pain(more and VAS 5 (0 to 10)) and their masseter muscles were examined with a tactile sensor in order to evaluate changes of stiffness and elasticity according to gum chewing and three physical therapeutic modalities. Subjective discomfort or pain was self-estimated by VAS as well. Unilateral gum chewing increased stiffness and decreased elasticity only on the chewing side but VAS increased on the both sides(p<0.05). EAST or Microwave diathermy greatly decreased stiffness and VAS and increased elasticity(p<0.05) but LLLT did not exhibit significant difference. From the results of this study, it is concluded that both EAST and Microwave diathermy have favorable effect on stiffness and elasticity of muscles and pain relief while effect of LLLT is not reliable. In addition, experimental unilateral gum chewing compromises stiffness and elasticity of masseter muscles only the chewing side while subjective discomfort or pain can be felt on the both sides.

한국인 턱관절장애 환자의 유병률과 진료 양태

양희영,김미은,Yang, Hee-Young,Kim, Mee-Eun 대한안면통증구강내과학회 2009 Journal of Oral Medicine and Pain Vol.34 No.1

While previous epidemiological studies on temporomandibular disorders (TMD) have been based on a given health center or population sample, no study has been performed on general population of Korea, especially concerning about treatment pattern such as clinician’s specialty involved in TMD treatment, types and amount of prescription medication and cost. This study aimed to investigate magnitude of health visits and treatment patterns for Korean patients with TMD through the computerized database of Health Insurance Review and Assessment Service (HIRAS). Inclusion criteria were all patients registered on the HIRAS database over 3 years' period from 2003 to 2005 and the medical records of patients with TMD as a main diagnosis were extracted. Information collected was as follows; distribution related to gender, age and region and type of hospital the patients visited, treatment duration, clinicians' specialty involved in treatment, cost, types of prescription medication and surgical treatment. The results of this study indicated that 0.15% of the population yearly sought TMD treatment, presenting with increase of incidence over the three years. Most of TMD patients were women (99.8%) and the biggest age group was second and third decades and decreased with age. Seoul and Kyeonggi province presented with higher incidence of TMD compared to the other regions of Korea, which seems to be related with magnitude of population. 56% of TMD patients visited primary care sector and the numbers of treatment visits was the highest in dental clinic (38.4%), followed by orthopedics (28%) and ENT (13.6%) clinics in order. Duration of prescription medication was the longest for anti-inflammatory analgesics, followed by antipsychotic drugs and muscle relaxants. Inpatient care related to TMD was primarily performed in dental hospital compared to medical hospital. Medical database of HIRAS provided comprehensive and vast information on epidemiologic characteristics and treatment patterns for patients seeking TMD treatment, which can be more reliable data to expect medical demand for TMD in condition that accurate diagnosis and standardized treatment is delivered in clinical settings.

Changes of the Pharyngeal Space by Various Oral Appliances for Snoring

조철배,김미은,김기석,Jo, Chul-Bae,Kim, Mee-Eun,Kim, Ki-Suk Korean Academy of Orofacial Pain and Oral Medicine 2009 Journal of Oral Medicine and Pain Vol.34 No.3

The purpose of this study was to investigate the changes of the pharyngeal space when the following appliances were inserted: the mandibular advancement appliance (MAA), tongue retaining appliance (TRA), and mandibular advancement-tongue retaining appliance (MATRA). Nine male dental students exhibiting Class I occlusion, normal body mass index (BMI), and no signs and symptoms of snoring were selected for this study. The three kinds of snoring appliances (MAA, TRA and MATRA) were fabricated for each subject. The mandibular advancement of the MAA and MATRA was set at a distance of 5 mm, and the TRA and MATRA were made to hold the tongue in front of the maxillary incisors by 10 to 20 mm. Lateral cephalometric radiographs of the following four states - with no appliance, MAA, TRA, and MATRA - were taken to examine any anatomical changes resulting from the application of the appliances. All four radiographs were traced and analyzed for twenty selected variables related to the pharyngeal space, cranio-cervical posture, and position of the soft palate and hyoid bone. According to the results of this study, there were significant increases in both the upper and lower oropharyngeal spaces when the mandible and tongue were protruded simultaneously, although there was a significant increase only in upper oropharyngeal space when the mandible or tongue was advanced separately. In conclusion, it is suggested that the MATRA may result in more positive effect on the control of snoring and OSA compared to a single use of the MAA or TRA, especially for the patients whose upper airway obstruction occurs in the lower oropharynx.

하악신경영역에서 전류인지역치를 이용한 정량적 감각신경 검사의 재현성 조사

최희훈,김미은,김기석,Choi, Hee-Hun,Kim, Mee-Eun,Kim, Ki-Suk 대한안면통증구강내과학회 2011 Journal of Oral Medicine and Pain Vol.36 No.2

Current Perception Threshold (CPT) using Neurometer($Neurometer^{(R)}$ CPT/C) is thought as one of easy and noninvasive QST(qunatitative sensory testing) tools for A${\beta}$, A${\delta}$ and C fibers within a relatively short time. However, conflicts about its reliability still exist. This study aimed to evaluate the reliability of CPTs evaluation and find a way to increase its reliability. Two examiners separately tested CPTs at each side of the mandibluar nerve areas for ten healthy male adults (average age of 22.4 years) three times with an intervals of a week during three weeks. Mean CPTs were compared between the right and left sides of the mandibular nerve area and between the three examinations on the each side. While CPTs at 2000 Hz(A${\beta}$ fiber) showed statistically significant side differences in all three examinations (p<0.05), significant side difference was found in only one examination at 250 Hz(A${\delta}$ fiber) and no difference at 5 Hz(C fiber). Comparing CPTs on the each side of the mandibular nerve area, all examinations at all sensory nerve fibers showed the least CPTs at the 1st examinations. CPTs at 250 Hz(A${\delta}$ fiber) and 5 Hz(C fiber) were significantly different between the first and the following examinations (p<0.05) and there was no significant difference between 2nd and 3rd examinations. The results of this study indicated that CPTs at 250 Hz(A${\delta}$ fiber) and 5 Hz(C fiber) are reliable but CPTs at 2000 Hz(A${\beta}$ fiber) is not appropriate for evaluation of side differences in the mandibular nerve area. In addition, it is suggested that repeated examination be helpful to increase reliability of the CPT evaluation.

Evaluation of the Bite Forces in Patients with Unilateral Temporomandibular Disorders

이우정,김미은,김기석,Lee, Woo-Jung,Kim, Mee-Eun,Kim, Ki-Suk Korean Academy of Orofacial Pain and Oral Medicine 2006 Journal of Oral Medicine and Pain Vol.31 No.4

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.

Occlusal Analysis of the Subjects with Chewing Side Preference Using the T-Scan II System

박은희,김미은,김기석,Park, Eun-Hee,Kim, Mee-Eun,Kim, Ki-Suk Korean Academy of Orofacial Pain and Oral Medicine 2006 Journal of Oral Medicine and Pain Vol.31 No.3

While orofacial pain or various dental factors are generally considered as the primary cause of unilateral chewing tendency, there exist several studies indicating that dental factors did not affect the preferred chewing side. The aim of this study was to examine difference of occlusal scheme between the subjects with and without chewing side preference. The difference between the chewing and non-chewing sides in the unilateral chewing group was investigated as well. Computerized, T-Scan II system was used for occlusal analysis. 20 subjects for the unilateral chewing group (mean age of $25.25{\pm}2.84$ years) and 20 subjects for the bilateral chewing group (mean age of $27.00{\pm}5.07$ years) were selected by a questionnaire on presence or absence of chewing side preference and those with occlusal problem or pain and/or dysfunction of jaw were excluded. T-Scan recordings were obtained during maximum intercuspation and excursion movement. The number of contact points, relative occlusal force ratio between right and left sides, tooth sliding area and elapsed time throughout the maximum intercuspation were calculated. Elapsed time for excursion was also investigated. The results of this study shows that the unilateral chewing group had the smaller average tooth contact areas compared with those of the bilateral group (p<0.005). In the unilateral chewing group, the contact areas of non-chewing side are smaller than those of chewing side (p<0.005). The contact areas on their preferred sides were not significantly different with those of right or left side of the subjects without chewing side preference. There was no significant difference in the elapsed time during maximum intercuspation and lateral excursion, the sliding areas and relative of right-to-left occlusal force ratio between the two groups. From the results of this study, it is likely that individuals prefer chewing on the side with more contact areas for efficient chewing.