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측두하악장애 연구진단기준(RDC/TMD)를 이용한 측두하악장애의 근육성 동통과 관절성 동통 환자군의 비교
Comparison of Myogenous and Arthrogenous Pain Patients of Temporomandibular Disorders using Research Diagnostic Criteria for Temporomandibular Disorders 원문보기

대한구강내과학회지 = Korean journal of oral medicine, v.37 no.4, 2012년, pp.233 - 242  

박주선 (서울대학교 치의학대학원 구강내과진단학교실, 치학연구소) ,  김동희 (서울대학교 치의학대학원 구강내과진단학교실, 치학연구소) ,  정진우 (서울대학교 치의학대학원 구강내과진단학교실, 치학연구소)

초록
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본 연구의 목적은 근육성 동통 및 관절성 동통을 가진 측두하악장애 환자를 대상으로 측두하악장애 연구진단기준(RDC/TMD) axis II 지수 및 관련 요소들을 비교하여 동통과 관련된 장애와 사회심리학적 상태 그리고 치료에 미치는 영향을 알아보는데 있다. 서울대학교 치과병원 구강내과를 내원한 측두하악장애로 진단되어진 252명의 환자들을 대상으로, 측두하악장애 연구진단 기준을 이용하여 근육성 동통군, 관절성 동통군, 근육성 동통과 관절성 동통을 모두 보이는 혼합형 동통군으로 분류한 뒤, 측두하악장애 연구진단기준 설문지를 이용하여 통증의 강도, 동통과 관련된 장애 일수, 만성통증척도, 우울 지수, 신체화 지수, 하악기능과 관련된 기능제한 등을 조사하였으며, 동통의 기간, 치료 기간 및 치료 효과 등 임상적 요소들과의 관계를 분석하여 다음과 같은 결과를 얻었다. 1. 연구대상자의 17.5%가 근육성 동통군, 31.0%에서 관절성 동통군, 51.6%가 혼합형 동통군으로 분류되었다. 성별 분포는 여성이 남성보다 높았으나 세 그룹간의 연령 및 성별은 통계적으로 유의한 차이를 보이지 않았다. 2. 측두하악장애 각 통증군의 사회심리학적 상태는 통계적으로 유의한 차이를 보여주었다(p<0.01). 관절성 동통군에 비해 혼합형 동통군에서 통증의 강도, 동통과 관련된 장애 일수, 만성통증척도가 높게 나타났으며(p<0.01), 우울 지수 및 신체화 지수는 관절성 동통군에 비해 근육성 동통군과 혼합형 동통군에서 유의하게 높게 나타났다(p<0.01). 3. 하악기능과 관련된 기능제한은 각 군간 통계적으로 유의한 차이를 보이지 않았으나 최대 개구량은 근육성 동통군 환자보다 관절성 동통군 환자에서 작게 나타났다(p<0.05). 4. 관절성 동통군 환자들은 다른 동통군의 환자들에 비하여 적은 수에서 만성 동통의 경향을 보였으며 (p<0.01), 혼합형 동통군의 환자들은 다른 동통군의 환자들에 비하여 상대적으로 낮은 치료 효과를 나타내었다(p<0.01). 5. 측두하악장애 환자의 치료 효과는 신체화 지수와 높은 관련성을 나타내었다. (${\beta}$=-0.251, p<0.05)

Abstract AI-Helper 아이콘AI-Helper

The purposes of this study were to compare psychological profiles, to investigate the differences in the clinical characteristics, and to compare treatment outcomes between myogenous pain and arthrogenous pain subgroups of temporomandibular disorder (TMD) based on Research Diagnostic Criteria for Te...

주제어

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제안 방법

  • After the RDC/TMD questionnaires were completed, clinical examination was performed according to the RDC/TMD. The clinical examination involves clinical assessment of TMD signs and symptoms including pain site, mandibular range of motion and associated pain, joint sounds, muscles and joint palpation or tenderness.
  • The clinical examination involves clinical assessment of TMD signs and symptoms including pain site, mandibular range of motion and associated pain, joint sounds, muscles and joint palpation or tenderness. For evaluation of the existence of contributing factors, the 17 parafunctional habits (sleep bruxism, daytime clenching clenching, perioral contraction, tongue thrusting, frequent hard food mastication, unilateral chewing, unilateral sleep, high pillow, biting something, irregular diet, chin buttressing, coffee, insomnia, indigestion, bad posture, much talking, cold weather) were assessed using standardized questionnaire used in our clinic.
  • Method of assessing depression and somatization was derived from Symptom Checklist-90-Revision (SCL-90-R). Participants responded to 13 items of depression parameter and 7 items of additional parameter of SCL-90-R, and then resultant raw mean score was regarded as depression scale. Somatization scale was also obtained by raw mean score from the responses to 12 items of non-specific physical symptoms of SCL-90-R.
  • RDC/TMD axis II history questionnaire was administered to each patient before treatment. We used a systematically translated Korean version of RDC/TMD.
  • Two hundred and fifty two TMD patients were selected and divided into three groups based on the RDC/TMD axis I diagnostic guidelines; myogenous pain group, arthrogenous pain group, and mixed pain group. RDC/TMD axis II profiles, contributing factors, clinical findings, and treatment outcomes of three TMD subgroups were analyzed. Myogenous pain group had higher depression (p=0.
  • After the RDC/TMD questionnaires were completed, clinical examination was performed according to the RDC/TMD. The clinical examination involves clinical assessment of TMD signs and symptoms including pain site, mandibular range of motion and associated pain, joint sounds, muscles and joint palpation or tenderness. For evaluation of the existence of contributing factors, the 17 parafunctional habits (sleep bruxism, daytime clenching clenching, perioral contraction, tongue thrusting, frequent hard food mastication, unilateral chewing, unilateral sleep, high pillow, biting something, irregular diet, chin buttressing, coffee, insomnia, indigestion, bad posture, much talking, cold weather) were assessed using standardized questionnaire used in our clinic.
  • The history questionnaire includes three questions to grade pain intensity: one for the actual pain, one for maximal pain in the last 6 months, and one for average pain in the last 6 months. The response options for each of three items were based on the ordinal rating of 0 to 10 scales.
  • The parameters of psychological profiles including depression and somatization, jaw disability, pain intensity, disability days, and graded chronic pain scale were analyzed. Method of assessing depression and somatization was derived from Symptom Checklist-90-Revision (SCL-90-R).
  • A total of 308 (61 male and 237 female) consecutive patients with TMD who visited at the Orofacial Pain Clinic of Seoul National University Dental Hospital, were recruited. The patients were divided into three groups based on the RDC/TMD axis I diagnostic guidelines14); Group A- patients with only myogenous pain, Group B- patients with only arthrogenous pain, and Group C- patients with both myogenous pain and arthrogenous pain (mixed pain). Of the 308 patients, 56 were excluded because of no symptoms of pain or not fit in the criteria described below.
  • The purposes of this study were to compare psychological profiles, to investigate the differences in the clinical characteristics, and to compare treatment outcomes among myogenous pain, arthrogenous pain, and mixed pain subgroups of TMD using Korean version of RDC/TMD.
  • TMD refer to a collection of medical and dental conditions affecting the TMJ and/or the muscles of mastication, as well as contiguous tissue components. The purposes of this study were to compare psychological profiles, to investigate the differences in the clinical characteristics, and to compare treatment outcomes between myogenous pain and arthrogenous pain groups of TMD based on RDC/TMD.

대상 데이터

  • A total of 308 (61 male and 237 female) consecutive patients with TMD who visited at the Orofacial Pain Clinic of Seoul National University Dental Hospital, were recruited. The patients were divided into three groups based on the RDC/TMD axis I diagnostic guidelines14); Group A- patients with only myogenous pain, Group B- patients with only arthrogenous pain, and Group C- patients with both myogenous pain and arthrogenous pain (mixed pain).
  • Two hundred and fifty two TMD patients were selected and divided into three groups based on the RDC/TMD axis I diagnostic guidelines; myogenous pain group, arthrogenous pain group, and mixed pain group. RDC/TMD axis II profiles, contributing factors, clinical findings, and treatment outcomes of three TMD subgroups were analyzed.

데이터처리

  • One-way ANOVA was used to analyze separately the differences between the three groups on pain intensity, disability days, graded chronic pain scale, depression, nonspecific physical symptoms (pain item included), nonspecific physical symptoms (pain item excluded) and jaw disability. Chi-square tests were used for analyzing group differences on bruxism, clenching, unilateral chewing, insomnia, and headache.
  • Table 5. Standardized coefficients of gender, age, and RDC/TMD axis II profiles on the treatment effectiveness in the multiple linear regression model.

이론/모형

  • The parameters of psychological profiles including depression and somatization, jaw disability, pain intensity, disability days, and graded chronic pain scale were analyzed. Method of assessing depression and somatization was derived from Symptom Checklist-90-Revision (SCL-90-R). Participants responded to 13 items of depression parameter and 7 items of additional parameter of SCL-90-R, and then resultant raw mean score was regarded as depression scale.
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