Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지

Prognosis of Conservative Therapy on the TMD Patients with Noise

측두하악장애 환자의 관절음에 대한 보존적 처치의 예후

Ko, Myung-Yun;Cho, Soo-Hyun;Ahn, Yong-Woo
고명연;조수현;안용우

  • Published : 20030300
⟨ Previous Next ⟩

Abstract

The purpose of this study was to evaluate the therapeutic effect and prognosis of the symptoms of temporomandibular disorders (TMD) and treatment response of joint sound after conservative therapy with behavioral modification, pharmacotherapy, physical therapy and stabilization splint in TMD patients with painful joint sound. The subjects for this study were recruited from one hundred and forty-four new TMD patients in the Department of Oral Medicine at the Pusan National University Hospital from 1987 to 2001. Each patient was examined on the symptoms of TMD with a self-administered questionnaire, comprehensive history taking and clinical examination, including muscle and TM joint palpation, evaluation of jaw function, and joint noises. All subjects were diagnosed as the masticatory muscle disorders (MMD), the internal derangement (ID), the degenerative joint disease (DJD) and/or the combined disorders. The pattern of joint sounds was classified into click, crepitus, and pop. Therapeutic effects were evaluated by the subjective pain perception and the severity of noise (numerical analogue scale, NAS), maximum comfortable opening (MCO). Statistical analysis was performed to evaluate the changes of symptoms, especially treatment response of joint sound, only after physical therapy and after stabilization appliance with physical therapy with chi-square and t-test. Regardless of several classifications in this study, the symptoms of TMD were significantly improved after conservative therapy (P<0.05), and the major improvement was observed after stabilization appliance with physical therapy. 42.11% of TMD patients with click had reported no joint sound after stabilization appliance with physical therapy (P<0.05). However, no significant change was found in TMD patients with crepitus and pop. Therefore, we conclude that TMD patients with pain and dysfunction have overall improvement with conservative therapy and a combination treatment appear to be more effective than single treatment.

Keywords

References

  1. Stegenga B. : Temporomandibular joint osteoarthrosis and Internal Derangement ; Diagnostic and Therapeutic outcome assessment[Thesis]. The Netherlands : University of Groningen. 1991
  2. Okeson J.P. : Orofacial pain; Guidelines for assessment, classification, and management. The American Academy of Orofacial Pain, Quintessence Co., 1996, pp 129
  3. Westesson P-L, Bifano J.A., Tallents R.H., et al. : Increased horizontal angle of the mandibular condyle in abnormal temporomandibular joints ; A magnetic resonance imaging study. Oral Surg. Oral Med. Oral Pathol. 72:359-363, 1991
  4. Nilner M., Petersson A. : Clinical and radiological findings related to treatment outcome in patients with temporomandibular disorders. J. Dentomaxillofac. Radiol., 24:128-31, 1995
  5. Widmer C. : Temporomandibular joint sounds ; A critique of techniques for recording and analysis. J. Craniomandib. Disorder., 3:213-7, 1989
  6. Watt D.M. : Temporomandibular joint sounds. J. Dent., 8:119-127, 1980
  7. 정성창외 역. 악관절 장애와 교합. 4판, 서울. 군자출판사, 1999, pp 182-83
  8. Farrar W.B., McCarty W.L. : Inferior joint space arthrography and characteristics of condylar paths in internal derangements of the TMJ. J. Prosthet. Dent., 41:548-55, 1979
  9. Gage J.P. : Collagen biosynthesis related to temporomandibular joint clicking in childhood. J. Prosthet. Dent., 53:714-7, 1985
  10. Hansson T., Nilner M. : A study of the occurrence of symptoms of the temporomandibular joint masticatory musculature and related structure. J. Oral. Rehabil., 2:313-24, 1975
  11. Kopp S. : Clinical finding in temporomandibular joint osteoarthrosis. Scand. J. Dent. Res., 85:434-43, 1977
  12. Rasmussen O.C. ; Longitudinal study of transpharyngeal radiography in temporomandibular arthropathy. Scand. J. Dent. Res., 88:257-68, 1980
  13. Rasmussen O.C. : Clinical findings during the course of temporomandibular arthropathy. Scand. J. Dent. Res., 89:283-8, 1981
  14. Farrar W.B. : Differentiation of temporomandibular joint dysfunction to simplify treatment. J. Prosthet. Dent., 28:629-636, 1972
  15. Hardison D.J., Okeson J.P. : Comparison of three clinical techniques for evaluating joint sounds. J. Craniomandib. Prac., 8:307-11, 1990
  16. Magnusson T., Egermark-Ericksson I., Carlsson G.E. : Five year longitudinal study of signs and symptoms of mandibular dysfunction in adolescents. J. Craniomand. Pract.,4:338-344, 1986
  17. Greene C.S., Laskin D.M. : Long-term status of TMJ clicking in patients with myofascial pain and dysfunction. JADA, 117:461-465, 1988
  18. Wabeke K.B., Spruijt R.J. : On temporomandibular joint sounds: dental and psychological studies [Thesis]. Amsterdam: University of Amsterdam, 91-103, 1994
  19. Nilner M., Kopp S. : Distribution by age and sex of functional disturbances and diseases of the stomatognathic system in 7-18 year olds. Swed. Dent. J., 7:191-198, 1983
  20. Peck C.L., Kraft G.H. : Electromyographic biofeedback for pain related to muscle tension. Arch. Surg., 112:889-895, 1977
  21. Crockett D.J., Foreman M.E., Alden L., Blasberg B. : A comparison of treatment modes in the management of myofascial pain dysfunction syndrome. Biofeedback Self Regul., 4:279-291, 1987
  22. Au A.R., Klineberg I.J. : Isokinetic exercise management of temporomandibular joint clicking in young adults. J. Prosthet. Dent., 70:33-39, 1993
  23. Farrar W.B., McCarty W.L. : Clinical outline of TMJ diagnosis and treatment. Alabama: Walker Printing, 119-142, 1983
  24. Clark G.T. : Treatment of jaw clicking with temporomandibular repositioning: analysis of 25 cases. J. Craniomandib. Pract., 2:268-270, 1984
  25. Tallents R.H., Katzberg R.W., Macher D.J., et al. : Arthrographicallly assisted splint therapy: a 6-month follow-up. J. Prosthet. Dent., 56:224-225, 1986
  26. Anderson G.C., Schulte J.K., Goodkind R.J. : Comparative study of two treatment methods for internal derangement of the temporomandibular joint. J. Prosthet. Dent., 53:392-397, 1985
  27. Roberts C.A., et al. : Clinical and arthrographic evaluation of temporomandibular joint sounds. Oral Surg. Oral Med. Oral Pathol., 62:373-376, 1986
  28. Moloney F., Howard J.A. : Internal derangement of the temporomandibular joint. III. Anterior repositioning splint therapy. Aust. Dent. J., 31:30-39, 1986
  29. Tallents R.H., et al. : Use of protrusive splint therapy in anterior disk displacement of the temporomandibular joint: A 1 to 3 year follow-up. J. Prosthet. Dent., 63:336-341, 1990
  30. Dolwick M.F., et al. : Symptomatology of human TMJ surgical patients: a long-term follow-up (abstract 1185), J. Dent. Res., 66(special issue):96, 1987
  31. Montgomery M.T., Gordon S.M., Van Sickels J.E., Harms S.E. : Changes in signs and symptoms following temporomandibular joint disc repositioning surgery. J. Oral Maxillofac. Surg., 50:320, 1992
  32. Clark G.T., Lanham F., Flack V.F. : Treatment outcome results for consecutive TMJ clinic patients. J. Craniomandib. Disord., 2:87-95, 1988
  33. Okeson J.P., Hayes D.K. : Long-term results of treatment for temporomandibular disorders: An evaluation of patients. JADA, 112:473-478, 1986