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Conservative management of dislocated temporomandibular joints: A case report
박좋은,김혜경,최희훈,김미은,Park, Jo-Eun,Kim, Hye-Kyoung,Choi, Hee-Hoon,Kim, Mee-Eun The Korean Academy of Orofacial Pain and Oral Medi 2013 Journal of Oral Medicine and Pain Vol.38 No.4
턱관절의 탈구는 과두가 관절와를 벗어나 환자 스스로 원래 위치로 정복하지 못할 때 발생한다. 양측성 전방 탈구가 가장 흔하며 탈구의 빈도와 발생 기간에 따라 급성, 만성, 재발성으로 분류하기도 한다. 턱관절 탈구의 치료법으로 수조작 같은 보존적 방법부터 수술적 접근법까지 다양한 방법들이 있으며 치료법의 선택은 주로 탈구가 발생한 기간에 따라 달라진다. 본 증례를 통해서 수조작을 시행하여 턱관절의 탈구를 성공적으로 치료한 증례와 과두의 정복에 실패했으나 만성적으로 적응된 환자에서 수술적 치료 대신 보철 치료로 교합을 회복시켜준 사례를 소개하고 그 의의에 대해 고찰해보고자 한다. Dislocation of the temporomandibular joint (TMJ) occurs when the mandibular condylar head is displaced completely out of the glenoid fossa and cannot be reduced by the patient. The occurrence of bilateral anterior dislocation is the most common. Dislocations can be classified into three types in terms of duration and frequency of dislocation, i.e., acute, chronic and recurrent. There are various treatment modalities for dislocation from conservative try to surgical intervention. The selection for the appropriate modality mainly depends on the types of dislocation as previously stated. The authors report three cases of dislocation with different treatment modalities according to the duration of dislocation. In particular, we tried prosthetic approach instead of surgical intervention in the patient with chronic dislocation.
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Comparison of the Effects of Pilocarpine Solution and Tablet on Salivary Flow Rate
박좋은,송찬우,김기석,김미은 대한안면통증∙구강내과학회 2015 Journal of Oral Medicine and Pain Vol.40 No.1
Purpose: Pilocarpine has the effects on improvement of salivary flow and subjective symptomsfor xerostomic patients. Because of unwanted side effects following its systemic administration,topical pilocarpine has been paid attention as an alternative. This study aimed to investigateeffects of pilocarpine solution as mouthwash on salivary flow and adverse effects compared tosystemic administration of 5 mg pilocarpine tablet in healthy subjects. Methods: The study was a double blind, placebo-controlled, crossover clinical trial. Five milligramspilocarpine tablets, 4 mL of 2% pilocarpine solution and placebo solution were given to12 healthy volunteers (6 males and 6 females) in a predetermined order with wash-out periodof at least two days and unstimulated whole saliva was collected before and after administrationof each drug. Blood pressure and pulse rate was also measured and subjective effect andpotential side effects were evaluated by a self-administrated questionnaire. Results: Systemic (5 mg tablet) and topical (2% solution) use of pilocarpine significantly increasedsalivary flow rate in healthy subjects compared to placebo (p<0.001). In both the pilocarpinesolution and tablet groups, salivary flow rates at 120 minutes after administrationremained increased. Subjective effect on salivation was the largest in the pilocarpine tabletgroup, followed by the pilocarpine solution group (p<0.05). There was no significant differencein blood pressure and pulse rate after administration of all three drugs. Fewer side effects reportedin the pilocarpine solution group than in the tablet group. Conclusions: Two percents pilocarpine solution as mouthwash increases salivary flow rate,definitely superior to placebo solution and comparable to pilocarpine tablet, with fewer side effectsin healthy subjects. It indicates a possibility of pilocarpine solution as a useful alternativeof pilocarpine tablets for the xerostomic patients with systemic diseases.
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오현선,김혜경,박좋은,김기석,김미은,Oh, Hyun-Sun,Kim, Hye-Kyoung,Park, Jo-Eun,Kim, Ki-Suk,Kim, Mee-Eun 대한안면통증구강내과학회 2013 Journal of Oral Medicine and Pain Vol.38 No.1
우리 사회의 급속한 고령화로 인해 노인 인구는 이미 사회적으로나 의료계에 중요 연령집단으로 자리매김했으며 그 중요도는 향후 더욱 증가할 것이다. 특히 만성의 비치성 구강안면통증질환과 구강건조증, 하악운동이상증, 구강연조직질환 등을 주로 다루는 구강내과의 특성상 노인 환자들의 비중이 증가할 것이나 구강내과에 내원하는 노인 환자에 대한 연구는 부족하다. 그러므로 본 연구는 지난 10년 사이 치과대학병원에 내원하는 환자의 연령별 분포의 변화를 조사하고 특히 구강내과에 내원하는 노인 환자의 다양한 임상 특성을 조사하기 위하여 시행하였다. 본 연구는 2001년과 2011년의 단국대학교 치과대학 부속 치과병원의 초진환자에 대한 병원전산자료와 2011년 구강내과 환자의 챠트와 설문지 자료를 이용하여 후향적으로 시행되었다. 본 연구 결과, 지난 10년 사이에 치과병원과 구강내과의 노인환자 비율이 뚜렷하게 증가하였으며, 특히 구강내과의 노인환자는 2배 이상 증가하여 전체 치과병원 환자의 증가 (1.6배) 보다 뚜렷하였다 (p=0.000). 구강내과에 내원하는 18세 이상의 성인 환자의 13.5%는 노인환자였으며(남:녀=1:2.1), 이들 중 약 83%가 하나 이상의 전신질환을 가지고 있었다. 진단별로 볼 때 노인 환자들도 18~64세 사이의 일반 성인 환자들과 마찬가지로 턱관절장애의 비율이 가장 높았지만, 구강연조직질환, 구강건조증, 구강작열감증후군, 하악운동이상증의 발생이 성인 환자에 비해 많았다(0=0.000). 통증과 일상생활제한, 우울과 불안 역시 노인 환자들이 높았다 (p<0.05). 구강내과에 내원하는 노인환자들은 재발성 혹은 만성의 질환이 많고, 다양한 전신질환과 다수의 약물복용 등, 의사소통의 제한 등으로 인해 질병의 평가와 치료가 더욱 복잡해지고 제한되기 때문에 증가하는 노인환자의 효율적인 관리를 위해 평가법의 개선이나 특화된 관리가 필요하다. With Korea's rapid entry to aged society, elderly population has become a major age group both in the whole society and medical field and its importance will be constantly stressed out. Elderly population is also important in the field of oral medicine which deals with chronic and recurrent diseases in the orofacial region of non-dental origin but there exist few studies indicating epidemiology of elderly patients in this regards. This study aimed to investigate change of age distribution of new patients in a university-based dental hospital and oral medicine clinic for last decade and to investigate clinical epidemiology of elderly patients (${\geq}$ 65 years) of oral medicine clinic. This study was performed retrospectively using medical records of the new patients in Dankook University Dental Hospital in 2001 and 2011. According to the study, percentage of elderly new patients increased in both dental hospital and oral medicine clinic and degree of the increase was greater in oral medicine clinic than in the whole hospital (p=0.000). 13.5% of adult patients ${\geq}$ 18 years of oral medicine clinic were elderly patients ${\geq}$ 65 years. 83% of elderly patients were suffering from one or more systemic diseases. Although TMD was the most common reason for elderly patients who visited oral medicine clinic, oral soft tissue diseases, dry mouth, burning mouth syndrome and oromandibular dystonia was more frequently diagnosed in elderly patients compared to adult patients aged 18 to 64 years. Pain severity and interference of Brief Pain Inventory and depression and anxiety scores of Hospital Anxiety Depression Scales were higher in elderly patients than in the adult patients (p<0.05). Increase of elderly patients with chronic oral diseases and pain needs more attention of dentists and specialists of oral medicine to improvement of assessment and development of tailored management because large portion of the elderly patients have systemic diseases, polypharmacy and impaired communication, possibly restricting treatment options.
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