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문제 정의
- Controversy exists because of the limited knowledge regarding the etiology and natural history or course of temporomandibular disorders (TMDs). Therefore the treatment is focused on reduction of pain and adverse loading, improvement of function, and restoration of normal daily activities. The majority of patients suffering TMD achieve good relief of symptom with conservative therapy.
제안 방법
- The study concluded that a combination of physical therapy modalities in treatment of TMD patients was more effective than using just a single physical therapy modality. In this study the author applied different groups of treatment modalities to the subjects and tried to find the best treatment modalities for each diagnosis. However there was no significant difference in statistics and the overall results showed satisfactory outcome after conservative treatment, irrespective of the groups of treatment modalities applied.
- 88 patients with diagnosis of DD/cR and 60 patients with diagnosis of DD/sR were selected as the experimental group and 74 patients with diagnosis of masticatory muscle disorder (MMD) were selected as the control group. Subjective symptoms and clinical findings were investigated to evaluate and compare the subjects' status at the first visit and the last visit. The results were as follows;
- The author's previous study22) also supports this opinion. The author randomly assigned 54 TMD patients into two treatment groups (EAST applied group and EAST and ultrasound applied group) and compared the results after two weeks treatment. The study concluded that a combination of physical therapy modalities in treatment of TMD patients was more effective than using just a single physical therapy modality.
- 17) There are numerous published articles suggesting the success of a variety of treatment options but they may not be soundly substantiated with scientific evidence. Therefore the author selected patients with ADD which was the most common TMJ arthropathy shown in our clinics as the subjects and wanted to find out the characteristics and the treatment outcome of these patients after conservative treatment and to suggest adequate scientific evidence to support the appropriate treatment for patients with the diagnosis of ADD. At the first visit the main symptom of DD/cR patients is mostly joint sound and therefore noise score in DD/cR group was the highest compared to other groups.
대상 데이터
- The subjects were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Hospital, diagnosed as TMD and treated with conservative methods from 1994 to 2006 for 13 years. 88 patients with DD/cR and 60 patients with DD/sR were selected as the experimental group and 74 patients with MMD were selected as the control group.
- To evaluate the treatment outcome after conservative treatment in patients with TMJ disc displacement which is the most common temporomandibular joint arthropathy, the subjects were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Hospital, diagnosed as TMDs and treated with conservative methods from 1994 to 2006 for 13 years. 88 patients with diagnosis of DD/cR and 60 patients with diagnosis of DD/sR were selected as the experimental group and 74 patients with diagnosis of masticatory muscle disorder (MMD) were selected as the control group.
성능/효과
- 1. Pain, noise, LOM and MCO measurements of DD/cR, DD/sR and MMD groups were markedly improved after conservative treatments including behavior therapy, physical therapy, medication and splint therapy.
- 2. At the first visit, high score of pain in MMD group, high score of noise and large MCO measurement in DD/cR group and high LOM score in DD/sR group were observed. At the last visit, high score of noise and increased MCO measurement in DD/cR group and high score of pain and LOM in DD/sR group were observed.
- 4. DD/cR and DD/sR groups showed satisfactory outcomes after conservative treatments such as behavior therapy, physical therapy, medication and splint therapy while MMD group showed similar treatment outcome irrespective of the treatment modality used.
- 5. There was no difference in treatment outcomes after conservative treatments when the subjects were classified and compared according to gender, age group and chronicity.
- 6. MMD showed satisfactory prognosis in 10 treatments in less than 6 months while DD showed favorable prognosis in 10-20 treatments for 6 months to 2 years.
- At the first visit the main symptom of DD/cR patients is mostly joint sound and therefore noise score in DD/cR group was the highest compared to other groups. The main symptom of DD/sR patients is mostly LOM and therefore the LOM score was the highest in DD/sR group compared to other groups and MCO, the data which is able to evaluate LOM objectively also showed the least measurement. MCO in DD/cR group was larger than MMD group but LOM score was higher than MMD group.
- The author randomly assigned 54 TMD patients into two treatment groups (EAST applied group and EAST and ultrasound applied group) and compared the results after two weeks treatment. The study concluded that a combination of physical therapy modalities in treatment of TMD patients was more effective than using just a single physical therapy modality. In this study the author applied different groups of treatment modalities to the subjects and tried to find the best treatment modalities for each diagnosis.
- When treatment period groups with small number of subjects were excluded, MMD group tended to show 48.3% complete cure rate in less than 10 times of treatment while DD/cR and DD/sR groups tended to show 73% and 56.5% complete cure rate in 10-20 treatments respectively (Table 11).
후속연구
- Long-term study on the symptoms changed after their last visit is also needed to find out more reliable treatment outcome. The patients' symptoms and clinical findings were compared mostly with subjective data so more objective evaluation method is required for further studies.
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