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Purpose: This study is designed to analyse etiology and bone pattern at the first visit using cone-beam computed tomography (CBCT) and to evaluate the treatment outcome of conservative treatment in temporomandibular disorder (TMD) patients with rheumatoid arthritis (RA). Methods: One hundred condyles in 50 subjects with RA were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Dental Hospital, diagnosed as TMD. Condylar bone changes were classified by normal, erosive bony change, proliferative bony change and combined group (erosive bony change+proliferative bony change). They were treated conservatively with physical therapy, medication, behavioral therapy and/or occlusal stabilizing splint therapy. After 3 months on average, patients were re-evaluated with regards to subjective symptoms and the clinical findings were investigated. Results: TMD patients with RA have behavioral contributing factors such as parafunctional habit. The results that analyse bone pattern at the first visit using CBCT proliferative bony changes group (32.6%) were more common than erosive bony changes group (15.2%). In comparison between unilateral and bilateral bony change in temporomandibular joint, the ratio showed no significant differences. After 3 months of conservative treatments, pain, noise, limitation of motion (LOM) were markedly improved regardless of occlusal splint therapy. However only LOM was significantly improved through occlusal splint therapy during 3 months. Conclusions: TMD patients with RA had similar behavioral contributing factors and characteristics of CBCT images shown in general TMD patients and also similar response to conservative treatment so it is difficult to differentiate. Therefore when TMD patients show symptoms corresponding to clinical diagnostic criteria of RA at the first visit, serological testing should be conducted and through this, early diagnosis and treatment of RA should be initiated.

Purpose: Patients who suffer from rheumatic arthritis, fibromyalgia, other various inflammatory diseases and musculoskeletal disorders, which are all similar to temporomandibular disorders (TMD), have been complaining about changes in the level and type of pain in response to changes in weather conditions for a long time. Through an investigation about pain perception in TMD patients in response to weather conditions, our primary objective was to develop base materials for future studies on change in pain in response to meteorological factors. Methods: Among patients who presented with TMD to Department of Oral Medicine, Pusan National University Dental Hospital from August to October 2016, one hundred consecutive TMD patients diagnosed with TMDs according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC⁄TMD) were recruited for the study and 28 patients were excluded according to exclusion criteria. Survey was done with the questionnaire and investigated whether there was any difference in incidence and level of pain in TMD patients between non-rainy and rainy days. Results: Among a total of 72 samples, 4 patients reported change in pain on rainy days rather than non-rainy days. Two patients from chronic group (joint and complex subgroup) reported increased pain on rainy days rather than non-rainy days but it was not statistically significant (p＞0.05). One patient from chronic/muscle group reported the change in pain characteristics while pain intensity remained unchanged. One patient from acute/complex group reported decreased pain intensity. In comparison of the patients who reported increased pain on rainy days between acute and chronic groups, there were two reported cases and were both from chronic group only. There was a significantly higher chance of reporting increased pain on rainy days in chronic group than acute group (p＜0.001). Conclusions: It is considered that TMD patients couldn’t perceive the change in pain well in response to weather change on rainy days but some chronic patients could perceive the increase in pain in rainy days.

Purpose: To investigate the efficacy of pregabalin for patients with primary burning mouth syndrome (BMS) who are unresponsive to topical clonazepam therapy. Methods: By searching the clinical electronic records from the Department of Oral Medicine, Pusan National University Dental Hospital from 2012 to 2014, a retrospective analysis was performed on patients with primary BMS who were treated with topical clonazepam therapy during this period. Of the patients who were unresponsive to this therapy, 19 patients who were subsequently treated with pregabalin were included in the study. A pain assessment was performed using the 11-point numerical rating scale at first visit, following topical clonazepam therapy, and again after pregabalin therapy. The treatment outcomes were statistically analyzed using the Wilcoxon signed rank test. Results: Following additional pregabalin administration, the mean pain score was slightly reduced. A total of 7 patients reported a marked response (>50% pain reduction), and 3 patients reported a slight reduction in pain. Pain reduction following pregabalin therapy was statistically significant (p Conclusions: Pregabalin has a slight therapeutic effect on patients with primary BMS. Therefore, we recommend pregabalin as an alternative drug for BMS patients who are unresponsive to topical clonazepam therapy.

Purpose: The purpose of present study was to develop a method for assessing the chronological age of Korean adults based on the relationship between age and size of pulp cavity using dental radiographs of mandibular first molars. Methods: A total of 325 dental radiographs of Korean adults with known age and gender were selected for the study (199 males and 126 females) which were taken in the period between January 2009 and June 2014 at the Pusan National University Dental Hospital. The measurements were carried out on both orthopantomographs (OPGs) and intraoral periapical radiographs (IOPRs) of mandibular first molar and the following ratios were calculated: pulp chamber floor height ratio (F/L), pulp chamber ceiling height ratio (R/L), and pulp chamber depth ratio (D/L). Results: The ratios of measurements on intraoral periapical images of mandible first molar generally produce more reliable data than the measurements on OPGs. The pulp chamber floor height ratio and pulp chamber depth ratio showed significant correlation with age, whereas the pulp chamber ceiling height ratios showed weak correlation with age. It was found that the best correlations between the ratios and age were found for pulp chamber depth ratios (r= -0.732 to -0.751). The multiple regression models were derived using 3 ratios that were significantly correlated with age. The determination coefficients (R²) of the models ranged from 0.556 to 0.596. Conclusions: Our results indicate that the pulp chamber depth and pulp chamber floor height in mandibular first molar are an age-dependent variable in adults which can be used to estimate age with reasonable accuracy. The higher image quality of dental radiographs will probably narrow the age estimation error and improve dental age estimation.

Purpose: The purpose of this research was twofold: to compare the short-term efficacy of once-off education versus repetitive education (RE) of patients suffering from temporomandibular disorders (TMDs) and to determine whether there was any correlation amongst patient demographics, recommendation adherence degree and pain levels. Methods: A total of 848 patients with TMDs were enrolled. The control group consisted of patients who received a standard conservative treatment (STD) over at least 6 visits with education provided only during the first visit. The experimental group consisted of patients who received STD but had also been given RE (STD+RE). The RE was delivered through a standardized self-assessment questionnaire (SAQ) that was completed by the patient during each visit. Pain, which included maximum comfortable opening (MCO) of the mouth and limitation of mouth opening (LOM), was compared between the two groups. Behavior pattern and reported pain level changes in the group who used the SAQ were also analyzed. Results: The LOM was significantly improved in all of the experimental group patients (especially in females under 30 years of age, p＜0.05). The MCO was significantly higher in females (p=0.029). All of the patients displayed improvements in their habits following RE, which resulted in a strong correlation with pain reduction. Adhering to the recommendations regarding questions 14 and 15 of the SAQ appeared to have the greatest effect on pain reduction. Conclusions: These results clearly demonstrate that RE is more effective than once-off education for TMD patients who are female or under 30 years of age.

Purpose: This study was performed to investigate a correlation among oral hygiene habits, dryness of mouth, and self-perceived oral malodor and therefore to find out self-care methods which could be a help to reduce oral malodor. Methods: A survey of 296 dental undergraduate students of School of Dentistry, Pusan National University, who wrote consents voluntarily and participated in this study, was conducted using a questionnaire consisting of 17 questions and analyzed to investigate a correlation among oral hygiene habits (frequency of tooth brushing, water gargling, and drinking water, etc.), dryness of mouth indicating the amount of salivary secretion, and self-perceived oral malodor. Results: There was no significant correlation between mechanical cleaning factors and self-perceived oral malodor. The factor showing a strong correlation with severe self-perceived oral malodor was dryness of mouth (p=0.000). Conclusions: There was no correlation between mechanical cleaning habits and self-perceived oral malodor. Participants who felt self-perceived oral malodor more tended to have rather good mechanical cleaning habits. The factor showing a strong correlation with severe self-perceived oral malodor was dryness of mouth. Therefore trying to increase salivary secretion is considered to be a help to reduce self-perceived halitosis.

Purpose: The purpose of this study was to investigate occupational distribution of temporomandibular disorders (TMD) patients and their diagnosis according to occupations and to evaluate the relationship between TMD and occupations. Work-related factors which might aggravate TMD symptoms were also evaluated. Methods: We investigated 316 TMD patients, aged from 13 to 65 years old, who had visited the Department of Oral Medicine in Pusan National University Dental Hospital. The subjects who have a job were assessed using TMD analysis examination and occupation questionnaire. The level of significance was p-value Result: This study presented that the diagnoses according to occupations were not significant, but work-related factors such as verbal work and poor posture were related with TMD symptoms. Conclusions: Proper education is essential to prevent aggravation of TMD symptoms because TMD symptoms were more related to work environment than a specific occupation.

Received September 24, 2014 Revised October 7, 2014 Accepted October 20, 2014 This review provides an overview of the most commonly used dental age estimation techniques which focus on radiological methods in Korean adults. The literature from 1995 through July 31, 2014, was searched, using PubMed, for publications in English language. In PubMed, the keywords ‘tooth’ OR ‘dental’ AND ‘pulp’ AND ‘age estimation’ were searched. Inclusion criteria was comprised of the following: the subjects were living adults and dental radiography (excluded computed tomography [CT] and cone-beam CT) was used to measure the pulpal size. Twenty articles that met the criteria were selected. The method of age estimation using dental radiographs for measuring pulp and tooth size was represented in all studies. The methods were assorted into three categories generally; Kvaal’s, Ikeda’s and Cameriere’s methods. Those methods had certain limitations such as large error range and low correlation coefficient depending on populations, type of employed teeth and particular method. Various techniques and many studies have been published for age estimation from human teeth using dental radiographs, but those techniques showed various predictability and reliability. Therefore, future studies on larger samples with well-distributed age group using not only existing techniques but new techniques are necessary for deriving convincing results.

Purpose: The objective of this retrospective pilot study was to evaluate the effectiveness of Gabapentin in patients with primary burning mouth syndrome (BMS). Methods: Ten subjects were diagnosed with primary BMS (8 women and 2 men). The mean age was 60.1 years. They had clinical examination to exclude local factors such as the presence of Candida species, xerostomia, lichen planus, etc. They also underwent hematological examination to exclude secondary BMS due to systemic disorders. Pain was assessed by patients on an 11-point numerical rating score system (0 to 10). Gabapentin was administered at a starting dose of 300 mg/day, slowly titrated up to maximum of 1,800 mg/day. All patients were treated for 4 weeks. Results: One half of the patients (n=5) obtained reduction in pain over the treatment period. Four patients reported no reduction in pain symptoms. One patient reported that symptoms were worsening. The average pain score before the treatment was 6.3 and after the treatment was 5.25. No significant relationship was detected between pretreatment and posttreatment pain score. Only one patient noted mild side effect (dizziness). Conclusions: This retrospective pilot study provides no preliminary evidence that Gabapentin has effect in the management of BMS. However, further research (well-designed, randomized, and controlled trial with large sample) would be needed to investigate the efficacy of Gabapentin in treatment of BMS.

Purpose: This study aims to evaluate the changes in soft tissue thickness of the masseteric region after injection of botulinum toxin type A (BTX-A). Methods: Twenty-four data acquired from medical records were classified into 4 groups: bruxer group that received masseter muscle injection only (M-B), bruxer group that received both masseter and temporalis muscle injections (MT-B), non-bruxer group that received masseter muscle injection only (M-NB) and non-bruxer group that received both masseter and temporalis muscle injections (MT-NB). Injection dose of BTX-A was 30 units for each masseter muscle and 20 units for each temporalis muscle. We measured the reduced thickness of the masseteric region before and after 12 weeks after injection using cone-beam computed tomography. Results: Among the patients that received both masseter and temporalis muscle injections, bruxer group showed a tendency to have more reduction in masseter muscle thickness than non-bruxer group. The difference in reduced thickness between M-B and MT-B tended to show greater than the difference between M-NB and MT-NB. Conclusions: In case of masseter hypertrothy patients with bruxism there was a tendency to show a difference in reduced thickness of soft tissue between the group that received both masseter and temporalis muscles injection and the group that received masseter muscle injection only hence a thorough inspection before the injection of BTX-A is condisered to be needed.

Purpose: The purpose of this study was to compare the clinical and radiographic features of temporomandibular joint (TMJ) osteoarthritis (OA) between adolescents and middle-old aged patients. Methods: The subjects were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Hospital and were diagnosed with TMJ OA by clinical exam, X-ray and cone-beam computed tomography (CBCT) from 2010 to 2011. We investigated 93 adolescent patients (12-19 years) and 53 middle-old aged (>45 years) patients who observed the erosive bony changes in TMJ. CBCT scans were retaken at intervals at an average of 8 months. Results: The adolescent patients showed unilateral degenerative changes more often, and the middle-old aged patients showed degenerative changes more frequently on both sides. The transition of bone changes to the improved group occurred most commonly in both the adolescent and middle-old aged patients. The adolescent patients were more likely to improve than middle-old aged patients. In the adolescent patients, loss of erosion and subjective symptoms occurred in shorter periods than in the middle-old aged patients. In the adolescent patients, the transition of erosion was distributed into proliferative, normal, and shortening in order. In the middle-old aged patients, the transition of erosion was distributed into shortening, proliferative, and normal in order. Conclusions: The clinical and radiographic features of TMJ OA are a significantly different between the adolescent and middle-old aged patients. Moreover, the difference by age of the adaptive and regenerative capacity of TMJ affects the prognosis of TMJ OA and adolescent patients have a better prognosis after treatment.

2009년부터 2012년까지 부산대학교치과병원 구강내과에 측두하악장애를 주소로 내원한 만 12세-19세(평균나이 : 15.75 ± 2.17세)의 청소년환자 중 임상검사, 방사선검사 및 전산화 단층촬영 (Cone Beam Computed Tomography, CBCT)을 통하여 측두하악관절 골관절염으로 진단되고 하나이상의 과두나 하악와의 관절하골에서 erosive change를 보이는 149명 167개의 관절을 대상으로 하였다. 치료 후 평균 9개월(9.03 ± 4.64 개월) 이후 CBCT를 재촬영하고, 임상검사를 재실시하였다. 구강내과 전문의와 치과 방사선과 전문의가 영상 진단을 하였고, 임상검사 결과와 CBCT의 영상 결과를 추적 연구 비교하여 다음과 같은 결과를 얻었다. 1. 약물치료, 물리치료, 행동조절치료, 교합안정장치치료를 병행한 환자군은 교합안정장치치료를 병행하지 않은 환자군에 비해 치료 후 통증, 개구제한 증상에서 유의한 증상 개선을 나타냈다. 2. 교합안정장치치료를 병행한 급성환자군은 교합안정장치치료를 병행하지 않은 급성환자군보다 치료 후 통증, 관절잡음, 개구제한이 더 많이 개선되었고, 그 중 통증과 개구제한은 유의한 증상 개선을 보였다. 3. 치료 후 침식을 보이는 하악과두의 골변화 양상은 치료방법에 상관없이 개선되는 방향(improved)으로 진행되었으나, 교합안정장치치료를 병행한 환자군에 비해서 교합압정장치치료를 병행하지 않은 환자군에서는 하악과두의 침식성 골변화가 더 악화(worsen)되어 나타나는 경우가 많았으며, 반대쪽 하악과두에 새로운 침식이 나타난 경우도 더 많이 관찰되었다.

측두하악장애를 주소로 하는 환자 276명에 대해 임상검사와 방사선검사를 시행하였다. 하악과두 저형성으로 진단된 189명의 실험군과 골관절염으로 진단된 87명의 대조군을 임상적으로 비교하여 다음과 같은 결과를 얻었다. 1. 하악 과두저형성은 골관절염과 임상적으로 많은 부분이 유사하였다. 2. 하악 과두저형성은 골관절염에 비하여 방사선적 진단부위와 통증부위의 일치율이 현저하게 낮았다. 3. 하악 과두저형성 양측이환군이 편측이환군에 비해 교합불편감 및 이악물기습관이 많았다. 4. 편측이환군 비교시 하악 과두저형성은 편측저작습관이 높았으며, 개구제한감을 더 많이 느꼈다. 골관절염은 아침의 불편감 및 두통을 많이 호소하였으며 진단부위와 단순관절음 일치율이 높았다. 5. 양측이환군 비교시 하악 과두저형성이 골관절염보다 평상시 두통을 더 많이 호소하였으며, 수평피개량도 컸다.

Background Oral lichen planus (OLP) is a chronic inflammatory disease characterized by cell-mediated immune responses, but the exact cause is unknown. Sulfasalazine has shown efficacy in the treatment of cutaneous lichen planus. Objective Our purpose was to assess the usefulness of sulfasalazine in treatment of OLP resistant to corticosteroid therapy. This study provides a new option for controlling OLP symptoms. Methods Two patients with the symptomatic reticular form of OLP were treated with 30 mg/5 ml of topical sulfasalazine for 8 to 15 weeks and were evaluated for symptom severity using a numerical analog scale during each week of treatment. The lesion size was measured using a 2 mm² grid. Results After 2 weeks of application, both patients reported improvements in their symptoms and lesions. Most of the lesions disappeared after 8 weeks of treatment without any side effects. Conclusion Topical sulfasalazine can be a successful treatment option for patients with oral lichen planus resistant to steroid therapy.

To evaluate the treatment outcome of occlusal stabilizing splint in patients with TMJ osteoarthritis, the 76 subjects were chosen among the patients who presented to the Department of Oral medicine of Pusan National University Hospital, diagnosed as TMJ osteoarthritis by cone beam computed tomography, x-ray and clinical exam, and treated with occlusal stabilizing splint from 2009 to 2011. They were treated with physical therapy and medication before occlusal stabilizing splint delivery and checked monthly after occlusal stabilizing splint delivery. Subjective symptoms and clinical findings were investigated to evaluate and compare the subjects` status at the first visit, splint delivery visit and the last visit. The results were as follows; 1. Pain, noise, LOM and MCO were significantly improved between the first visit and occlusal stabilizing splint delivery visit, and between occlusal stabilizing splint delivery and the last visit. 2. In the acute group, pain and noise were significantly improved between the first visit and occlusal stabilizing splint delivery visit. Pain, LOM and MCO were significantly improved between splint delivery visit and the last visit 3. In the chronic group, pain, noise and LOM were significantly improved between occlusal stabilizing splint delivery visit and the last visit.

2010년부터 2011년까지 양산부산대학교 치과병원 구강내과에 초진 내원한 외래환자 중 재발성 아프타성 구내궤양(RAU)으로 임상 진단된 환자 20명과 구강편평태선으로 임상진단 된 환자 33명, 부산대학교 치의학전문대학원생 59명을 대조군으로 정하고 간이정신진단검사를 시행하여 다음과 같은 결론을 얻었다. 1. RAU 환자군과 편평태선 환자군, 대조군은 9개 증상차원 기본척도의 T 점수 평균값은 모두 65 이하로 정상범위 내에 있었다. 2. RAU 환자군은 정상 대조군에 비하여 SOM 지수가 유의하게 높았으며 (P＜0.05), DEP 지수에서 높은 경향을 보였다. 3. RAU의 여성 환자군은 여성 대조군에 비하여 SOM, DEP, HOS 지수가 유의하게 높았고 (P＜0.05), ANX 지수에서 높은 경향을 보였다. 4. RAU 환자군은 편평태선 환자군에 비하여 HOS 지수가 유의하게 높았으며 (P＜0.05), O-C, I-S, DEP 지수에서 높은 경향을 보였다.

This study was designed to assess follow-up study of condylar bone changes using cone beam computed tomography in patients with osteoarthritis. The author performed clinical examination for osteoarthritis patients who visited Orofacial Pain Clinic, Department of Oral Medicine, Pusan National University Hospital. CBCT(Cone beam computed tomography) was taken for 228 joints in 114 subjects. After average 10 months, CBCT was retaken. A Oral medicine and Oral radiologist evaluated CBCT each other. Condyle bone changes were classified by no bone change, flattening, erosion, osteophyte and sclerosis. The obtained results were as follow. 1. The condylar bone changes of osteoarthritis in temporomandibular disorder were as follow: 1) The transitions of each types of condylar bone changes was maintained at the initial state of the majority. 2) The transition of erosion was distributed erosion, flattening, sclreosis, osteohyte in order. 3) The transition of flattening was distributed flattening, osteohyte, normal, sclreosis in order. 4) The transition of osteohyte was distributed osteohyte, erosion, sclreosis, flattening in order. 5) The transition of sclreosis was distributed sclreosis, osteohyte, erosion, normal in order. 2. The signs and symptoms according to transition of each types of condylar bone changes were as follow 1) In the transition of condylar bone changes from erosin to erosion, pain, noise, LOM and MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to flattening, pain, LOM, MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to no bony change, pain, noise, LOM had symptomatic improvement. In the transition of condylar bone changes from erosion to flattening than the maintenance of eosion, MCO had symptomatic improvement. 2) In the transition of condylar bone changes from flattening to flattening, pain, noise and MCO had symptomatic improvement. In the transition of condylar bone changes from flattening to sclerosis, LOM had symptomatic improvement. 3) In the transition of condylar bone changes from osteophyte to osteophyte, pain, LOM and MCO had symptomatic improvement.

본 연구는 부산 청소년의 측두하악장애의 양태, 증상과 진단명에 대한 변화를 알아보기 위해 다음과 같은 조사를 시행하였다. 2000년과 2008년에 내원한 12-19세 청소년의 측두하악장애 분석검사를 조사하여 성별, 나이, 악관절환자를 위한 조사설문지, 원인, 진단명, 장치치료여부, 치료종결시 Pain NAS 항목에 대한 자료를 정리, 분석하였다. 1. 2000년도에 비해 2008년도의 청소년 내원 환자수가 증가했다. 이 중 남자 청소년의 비중이 현저히 증가했다. 2. 2000년도에 비해 2008년도의 청소년이 개구제한보다는 소리를 주소로 내원하는 경우가 많아졌으며 악습관 중 이갈이, 이악물기, 턱괴기, 수면의 질 저하 비율이 유의하게 증가하였다. 3. 골관절염은 유의하게 증가하였고 과운동은 유의하게 감소하였다. 4. 골관절염 환자에서2000년도에 비해 2008년도 10대 청소년의 남자비율이 현저히 증가하였다. 턱괴기, 이갈이, 이악물기 악습관을 가진 환자 중 지난 10년간 공통적으로 골관절염이 유의하게 증가한 것으로 미루어 턱괴기, 이갈이, 이악물기가 골관절염 발병 증가와 유의한 관계가 있을 것으로 추측할 수 있다.