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.

Secondary Dental Pain and Facial Pain Due to Pansinusitis : A Case Report

김남구,어규식,전양현,홍정표,Kim, Nam-Koo,Auh, Q-Schick,Chun, Yang-Hyun,Hong, Jung-Pyo Korean Academy of Orofacial Pain and Oral Medicine 2007 Journal of Oral Medicine and Pain Vol.32 No.3

Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures1). These odontogenic pains are managed well and predictably by dental therapies. One of the most frequent encounters and most confusing phenomena with which the dental diagnostician must deal is the problem of referred pain. The most important step toward proper management of a toothache is to consider that the pain may not be of dental origin. And Patients with orofacial pain, especially those in chronic pain, present a diagnostic and management challenge for the practitioners. There are many structures in the head and neck that can produce heterotopic pains felt in the teeth and other structures. Once referred pain is suspected, the true source of the pain must be located in order to render effective therapy. With increased interest in temporomandibular disorders and orofacial pain, many studies of accurate diagnosis and differential diagnosis about orofacial pain have been established. The purpose of this paper is to present a case for pansinusitis which produced pain referral in teeth and mimicked the symptoms of migraine.

Nerve Growth Factor and Sensory Neuropeptide Levels in Plasma and Saliva of Various Orofacial Pain Patients

장민욱,정성창,정진우,Jang, Min-Uk,Chung, Sung-Chang,Chung, Jin-Woo Korean Academy of Orofacial Pain and Oral Medicine 2009 Journal of Oral Medicine and Pain Vol.34 No.4

Nerve growth factor (NGF) and sensory neuropeptides are involved in the process of nociception at peripheral nerve fibers and wide spread in central nervous system. The aims of this study were to investigate NGF and sensory neuropeptides (substance P [SP] and calcitonin gene-related peptide [CGRP]) levels in human plasma and saliva, and the associations between these sensory neuropeptides levels and chronic orofacial pain symptoms. NGF, SP, and CGRP levels in plasma and resting whole saliva samples collected from 67 orofacial pain patients (joint pain, dental or periodontal pain, mucosal pain) and 36 pain free control subjects were measured by enzyme immunoassay. The characteristic pain intensity of each subject was measured using the Graded Chronic Pain Scale and the flow rate of resting whole saliva was measured. Joint pain patients group showed significantly higher plasma NGF level compared to each of dental pain patients (p<0.01), mucosal pain patients (p<0.01), and control group (p<0.01). Plasma NGF level of dental pain patients group was significantly higher than that of control group (p<0.01). Saliva SP level of dental pain patients group (p<0.05) and saliva CGRP level of mucosal pain group (p<0.05) were significantly higher than that of control group. Plasma and saliva SP levels of joint pain patients was significantly associated with pain intensity (plasma: standardized coefficient=0.599, p<0.01, saliva: standardized coefficient=0.504, p=0.05). In dental pain patients group, plasma SP (standardized coefficient=0.559, p<0.01), saliva SP (standardized coefficient=0.520, p<0.01) and saliva CGRP (standardized coefficient=0.599, p<0.01) levels were significantly associated with age. In mucosal pain patients group, plasma SP (standardized coefficient=0.495, p<0.05), saliva SP (standardized coefficient=0.500, p<0.05), and saliva CGRP (standardized coefficient=0.717, p<0.01) levels were significantly associated with age. NGF and neuropeptides may play a role in the maintenance of various orofacial pain symptoms. The examination of those levels in plasma and saliva helps understanding the mechanism of orofacial pain, and furthermore, can be applied to the diagnosis and therapy of orofacial pain.

Pain Disability of Orofacial Pain Patients

최세헌,김기석,김미은,Choi, Se-Heon,Kim, Ki-Suk,Kim, Mee-Eun Korean Academy of Orofacial Pain and Oral Medicine 2009 Journal of Oral Medicine and Pain Vol.34 No.2

As Pain is a comprehensive, biopsy chosocial phenomenon, improved understanding and successful management of pain need assessment of health-related quality of life and psychological states. The purpose of this study was to evaluate pain severity and pain-related interference to daily lives for patients with non-dental, orofacial pain(OFP) and a possible relation of OFP with psychological morbidity. Relation with such factors as gender, age, pain duration and diagnosis was also assessed. Inclusion criteria was all new patients with non-dental OFP attending the oral medicine.orofacial pain clinic of Dankook University Dental Hospital over 3 months' period, who completed the questionnaires of the Brief Pain Inventory (BPI) and Hospital Anxiety and Depression Scale (HADS). Prior to the first consultation, the patients were asked to fill out the questionnaire in the waiting room and were diagnosed through consultation and clinical examination. Total subjects were 163 with M:F ratio of 1:1.5 and mean age of 34.6${\pm}$17.7 years. Mean duration of pain was 13.3${\pm}$26.2 months and all patients were divided into; Trigeminal Neuralgia group (TN, N=8), Neuropathic Pain group (NeP, N=9), Persistent Idiopathic Facial Pain group (PIFP, N=8), and Temporomandibular Disorders group (TMD, N=138), subdivided into muscle problem (TMD-m, N=73), joint problem (TMD-j, N=24) and muscle-joint combined problem (TMD-c, N=41). OFP patients showed moderate pain severity and moderate pain-related interference. There was no gender difference in overall pain severity and interference and levels of anxiety and depression. Elderly patients aged ${\geq}$ 60 years showed higher pain severity (p<0.05). Patients with chronic pain ${\geq}$ 3 months reported more increased level of anxiety and depression than those with acute pain (p<0.05). Compared to TMD patients, patients with TN, NeP and PIFP suffered from higher level of pain and pain-related interference and reported higher level of anxiety and depression (p<0.05). Pain interference was closely correlated with their pain severity and with psychometric properties such as anxiety and depression. Pain severity was weakly correlated with levels of anxiety and depression. The results suggest a need for psychosocial assessment and support for successful management of OFP in addition to control of pain itself.

Ultrasound-guided Platelet-rich Plasma Prolotherapy for Temporomandibular Disorders

Moon, Seong-Yong,Lee, Sun-Tae,Ryu, Ji-Won Korean Academy of Orofacial Pain and Oral Medicine 2014 Journal of Oral Medicine and Pain Vol.39 No.4

Purpose: Temporomandibular disorder (TMD) is one of the most common diseases causing chronic orofacial pain. Prolotherapy is called 'regenerative injection therapy' or 'growth factor stimulation injection', and it induces the functional reactivation of tissues such as ligaments and tendons. The aim of this study is to evaluate the efficacy of ultrasound-guided prolotherapy with platelet-rich plasma (PRP) for the patients who had the TMD symptoms, especially in temporomandibular joint (TMJ) pain, restricted mouth opening, and TMJ sound. Methods: Twenty-seven patients visited Chosun University Dental Hospital with the symptoms of pain, restricted mouth opening, and TMJ sound were included in this study. When the patients visited the hospital, we measured; the degree of pain, range of mouth opening (ROM), and TMJ sound, and grouped them according to their chief complaints. TMJ pain and ROM were measured both at the first visit and the fourth week after the PRP injection, and also evaluated the impact of the treatment on their daily activities. Results: After the treatment, the patients in the TMJ pain group showed some improvement (visual analogue scale [VAS] 5.6 to 3.6), and the patients in the restricted mouth opening group exhibited increased ROM (26 mm to 32 mm; p<0.05). On the other hand, the patients in the TMJ sound group had no improvement. Conclusions: PRP prolotherapy could be effective for the treatment of TMJ pain and restricted mouth opening. However, further studies are still necessary in terms of TMJ sound and longterm effect of PRP prolotherapy.

Bite Force, Occlusal Contact Area and Occlusal Pressure of Patients with Temporomandibular Joint Internal Derangement

김기서,최종훈,김성택,김종열,안형준,Kim, Ki-Seo,Choi, Jong-Hoon,Kim, Seong-Taek,Kim, Chong-Youl,Ahn, Hyung-Joon Korean Academy of Orofacial Pain and Oral Medicine 2006 Journal of Oral Medicine and Pain Vol.31 No.3

Temporomandibular joint (TMJ) internal derangement, especially disc displacement with reduction (DDwR) is the most common TMJ arthropathy and has been thought to do some effects on masticatory performance. Measuring of maximal bite force has been widely used as objective and quantitative method of evaluating masticatory performance, but previous studies showed various results due to various characteristics of subjects and different measuring devices and techniques. In a few studies about the correlation of bite force and temporomandibular disorders (TMD), some authors reported that bite force and masticatory performance would be reduced in patients with TMD because of pain. But the correlation of changes in structure of articular disc and masticatory performance has not been well investigated yet. In this study, to investigate the influences of non-painful disc change on the masticatory performance, we measured the value of maximal bite force, occlusal contact area and occlusal pressure of 39 patients with non-painful DDwR of the TMJ using pressure sensitive film, and compared it with that of 59 controls. The results are summarized as follows: 1. The maximal bite force (P<0.01) and the occlusal contact area (P < 0.05) of the DDwR patients were greater than the controls. 2. There was no significant difference in occlusal pressure between the DDwR patients and the controls (P > 0.05). 3. The maximal bite force of the male group was greater than that of the female group (P < 0.05). However, the occlusal contact area and the occlusal pressure between the male and the female group didn't show significant difference (P > 0.05). From the results above, we can suggest that DDwR could be a factor of changing bite force, but more controlled, large scaled and EMG related further study is needed.

Evaluation of Quality of Life in Patient with Temporomandibular Disorders

정진숙,허윤경,최재갑,Jung, Jin-Suk,Hur, Yun-Kyung,Choi, Jae-Kap Korean Academy of Orofacial Pain and Oral Medicine 2006 Journal of Oral Medicine and Pain Vol.31 No.2

Objectives: To explore the quality of life in patients with temporomandibular disorders and to evaluate it in terms of source and duration of the pain. Methods: A total of 61 patients with temporomandibular disorders participated in this study. According to pain source, they were divided into 2 groups, masticatory muscle pain (MMP) group and intracapsular pain (ICP) group. And each group was divided into acute phase group (pain duration <6 months) and chronic phase group (pain duration=6 months). The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used to measure patients' quality of life. The scores for eight-scale profile and the physical component summary (PCS) and mental component summary (MCS) of the SF-36 were compared between groups (MMP vs. ICP and acute vs. chronic). Student t-test was used to analyze the difference of the scores of the SF-36 between MMP and ICP groups. Results: MMP group showed significantly lower score in the 3 scales of the SF-36 (Role limitations due to emotional problems, Vitality, Bodily pain) when compared to ICP group. In acute phase there was no significant difference between MMP and ICP group in PCS as well as MCS scores, but in chronic phase MMP group showed significantly lower MCS score than ICP group. Conclusions: The masticatory muscle pain in patients with temporomandibular disorders,negatively influences the quality of life especially in chronic phase, and the mental components of quality of life are significantly interfered in the TMD patients with chronic masticatory muscle pain.

Patient Expectations of Visiting Department of Oral Medicine for Burning Mouth Syndrome: Relationship between Expectations and Clinical and Psychological Characteristics

Kim, Hye-Kyoung,Kim, Mee-Eun Korean Academy of Orofacial Pain and Oral Medicine 2019 Journal of Oral Medicine and Pain Vol.44 No.4

Purpose: The aims of this study were to investigate the expectation of patients with burning mouth syndrome (BMS) and assess the relationship between patient expectations and clinical and psychological characteristics. Methods: Eligibility was retrospectively assessed on 93 patients with BMS. A total of five questionnaires on patients' expectation for a visit, pain, sleep quality (Pittsburgh Sleep Quality Index), cognition (Pain Catastrophizing Scale) and psychological distress (Symptom Checklist-90 revised) were measured. Results: Sixty-five patients were included in this study. The top 3 priorities of expectation for a treatment visit to the Department of Oral Medicine were as following; "I want my pain to be free"; "I want to understand why it hurts"; "I want to communicate better with doctors about pain". Patients with priority of pain relief showed poor sleep quality than patients who are more interested in the disease related information. Conclusions: To improve treatment outcomes of BMS, clinicians should improve their own understanding of patients who are suffering from BMS. Inquiring about the patient expectations may be one of them, and it would contribute to the enhancement of patients' overall well-being.

Association Between Temporomandibular Disorders and Cervical Muscle Pressure Pain

임영관,김재형,김병국,Im, Yeong-Gwan,Kim, Jae-Hyeong,Kim, Byung-Gook Korean Academy of Orofacial Pain and Oral Medicine 2008 Journal of Oral Medicine and Pain Vol.33 No.4

Aims: The aims of this study were to identify the association between cervical muscle pain and TMD by pressure pain response, and to find cervical muscles showing moderate to severe pressure pain that are correlated with masticatory muscle pain. Methods: Patients(n=129, female 65.9%, mean age 28.8 years) answered a TMD questionnaire asking about headache, neck pain, emotional stress, sleep disturbance, parafunction habits, and pain intensity. A clinical examination of the masticatory system was performed. Of the neck muscles, (1) the upper sternocleidomastoid, (2) the middle sternocleidomastoid, (3) the upper trapezius, (4) the splenius capitis, (5) the semispinalis capitis, (6) the scalene medius, and (7) the levator scapulae muscles were examined by palpation. Pressure pain or tenderness of all palpation sites was scored from 0 to 3 according to the pain response. The variables of sum of pressure pain scores were calculated from pressure pain scores and were used for statistical analyses. Results: Eighty patients(62.0%) answered that they suffer from neck pain in the TMD questionnaire. More than 40% of sternocleidomastoid and upper trapezius examination sites showed moderate to severe tenderness in the cervical muscles, and 36% of middle masseter in the masticatory muscles. For the 129 patients, the sum of cervical muscle pain scores(mean=12.88, SD=8.06) and the sum of TMD pain scores(mean=5.36, SD=5.10) were moderately correlated($\rho$ = 0.502, P < 0.001). The sum of TMD pain scores tends to increase as the sum of cervical muscle pain scores increases(Y = 0.395${\cdot}$X, $R^2$ = 0.659, P < 0.001). In the patients with masticatory muscle disorders, the sum of sternocleidomastoid and upper trapezius pain scores(mean = 8.67, SD = 4.95) and the sum of temporalis and masseter pain scores(mean = 3.37, SD = 3.56) showed moderate correlation($\rho$ = 0.375, P < 0.001). Those two variables were in a proportionate relationship(Y = 0.359${\cdot}$X, $R^2$ = 0.538, P < 0.001). In a partial correlation analysis of the sum of unilateral pain scores, the sum of right cervical muscle pain scores and the sum of left cervical muscle pain scores showed the highest correlation(r = 0.802, P < 0.001). The sum of right TMD pain scores and the sum of left TMD pain scores were moderately correlated(r = 0.481, P < 0.001). For the twenty patients with unilateral TMD pain, the partial correlation coefficient between the sum of ipsilateral cervical muscle pain scores and the sum of contralateral cervical muscle pain scores was the largest(r = 0.597, P = 0.009). A partial correlation between the sum of primary TMD side pain scores and the sum of ipsilateral cervical muscle pain scores was 0.564(P = 0.015). Conclusions: TMD is associated with cervical muscle pain on condition of pressure pain response to palpation. Of the cervical muscles, sternocleidomastoid and upper trapezius frequently exhibit moderate to severe pressure pain, and they are closely related to the masticatory muscle pain. The characteristic of symmetric involvement of pain is prominent in cervical muscles; however, TMD can affect the level of cervical muscle pain to modify its symmetric nature.

Age Differences in Signs and Symptoms of Patients with Temporomandibular Disorders

Jo, Jung Hwan,Park, Ji Woon,Kim, Ji Rak,Seo, Hyong Duk,Jang, Ji Hee,Chung, Jin Woo Korean Academy of Orofacial Pain and Oral Medicine 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, clinical characteristics, distribution according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) subgroup, psychological profile of TMD patients, and to identify the prevalence and trend according to age. Methods: A total of 1,052 patients (261 men and 791 women; mean age, $34.40{\pm}15.73$ years) who visited the Orofacial Pain Clinic of the Department of Oral Medicine, Seoul National University Dental Hospital complaining of TMD symptoms of were evaluated. All patients were questioned for medical history, clinical symptoms and contributing factors. Clinical examination and patient grouping based on RDC/TMD was conducted. Radiographies were taken. The Korean version of RDC/TMD axis II and Symptom Checklist-90-Revision (SCL-90-R) were administered to 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 in all 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-year-old age group showed the highest distribution of high disability based on the graded chronic pain scale. Age was positively associated with pain intensity (r=0.100), number of positive muscles 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 distinct tendencies according to different age groups. Treatment should be customized and personalized according to age for efficient symptom resolution and patient satisfaction.