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Purpose@#The aim of this study was to compare changes of bite force, occlusal contact area, and dynamic functional occlusion analysis after occlusal stabilization splint therapy during sleep for one month in a patient with bruxism. @*Materials and Methods@#From October 2021 to July 2022, sleep bruxism of 30 patients who visited the Department of Oral Medicine at Yonsei University College of Dentistry Hospital were recruited. The participants were divided into two groups: using an occlusal stabilization splint during sleep (treatment; n = 15) and not using an occlusal stabilization splint (control; n = 15). Before using the occlusal stabilization splint and one month after, bite force, occlusal contact area and dynamic functional occlusion analysis (ratio of left/right bite forces, average bite forces, maximum bite forces, and maximum contact areas during lateral and anterior and posterior mandibular movements) were performed. @*Results@#There was no difference in bite force and occlusal contact area between the treatment group using the occlusal stabilization splint and the control group not using the occlusal stabilization splint during sleep for one month. However, there were significant differences in the average bite force and maximum bite force in the lateral and anterior and posterior mandibular movements and the maximum contact areas in the anterior and posterior mandibular movements. @*Conclusion@#The occlusal stabilization splint is helpful for sleep bruxism patients who lateral and anterior and posterior mandibular movements. In addition, further studies are needed a double-blind study with a large population.
ABSTRACT
A beautiful smile is made when it is symmetrical and gums are displayed less than 2 - 3 mm. Excessive gingival display also known as “gummy smile” is often recognized to be unaesthetic. Causes of gummy smile can be caused by delayed eruption, vertical maxillary excess, hypermobile upper lip, or a short upper lip. Meanwhile botulinum toxin which is an exotoxin produced from Clostridium botulinum, works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles.The application site and weakens the muscle tone is drawing attention as a gummy smile treatment caused by hypermobile upper lip. There have been many studies about the method of injecting botulinum toxin into muscles around the lips, but there is still no standardized research method and treatment method, so there is controversy over the therapeutic effect. The aim of this study is to review the previous studies about the predictors of indication and effects of gummy smile treatment using botulinum toxin injection. Especially we tried to propose a protocol for optimal dose and efficient injection point through the anatomical considerations for gummy smile treatment using botulinum toxin.
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Purpose@#To profile various clinical characteristics of sleep bruxism (SB) patients with idiopathic facial pain (IFP) in the orofacial region. @*Materials and Methods@#We analyzed 28 SB patients among 210 patients with IFP complaints. The profiles were evaluated using patient charts including gender, age, pain duration, pain location, pain intensity and affected areas by pain. @*Results@#SB with IFP occurred more often in females (85.7%) than males (14.3%). The mean age at presentation was 48.9 years. The most common IFP sites of SB patients were the right maxilla (28.6%) and the right mandible (25.0%). The pain complaints occurred mostly in 2 teeth or areas (50.0%), followed by 1 area (28.6%) and then in ≥ 3 teeth or areas (21.4%). The mean pain intensity was 5.9 on a visual analogue scale from 0 to 10. The pain was spontaneous in 20 patients (71.4%), and the mean pain duration was 24.4 months. @*Conclusion@#Identification of clinical characteristics of SB patients with IFP could be useful in the diagnosis of various IFP patients and beneficial in decreasing unnecessary care to reduce IFP. Further studies with larger number of subjects and extended duration are required for more systemized diagnostic methods and development of future treatment guidelines.
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Purpose@#There are many studies on the indications and efficacy of splint therapy commonly used in patients with temporomandibular disorders (TMD). However, there have been no studies on the splint weaning in terms of the splint use tapering period in relation to symptom improvement of TMD. This retrospective study aims to analyze a proper splint weaning method in patients with TMD based on symptom improvement. @*Materials and Methods@#The authors examined 130 TMD patients with TMJ disorders, masticatory muscle disorders, and clenching/bruxism who had received splint therapy (occlusion stabilization splint, anterior positioning splint) of patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital from 2015 to 2020. They were evaluated according to the method to wean splints. @*Results@#The mean splint therapy period was 29.0 months, during which patients wore splints 7 days a week for 8.4 months, 3 - 4 days a week for 9.5 months, and finally 1 - 2 days a week for 11.1 months (a total of 29.0 months, about 2.5 years). @*Conclusion@#It seems that TMD symptoms can be alleviated and side effects such as occlusal change can be minimized if patients wear a splint 7 days a week for the first 6 months, followed by 3 - 4 days a week for the next 6 to 18 months, and finally 1 - 2 days a week after 18 months.
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The aim of this study was to investigate the change of microbial contamination levels in the different areas and at the different time points after application of a quaternary ammonium compound (QAC) that has mechanical antimicrobial effect. The microbial contamination levels were measured in three different areas; unit chair handle, spit sink area and hand piece holder at different time points using adenosine triphosphate (ATP) monitoring system and ATP surface test kit. Hand piece holder showed the highest level of microbial contamination. In most of the clinics, QAC significantly reduced the levels of microbial contamination, and maintained antimicrobial activity for 4 to 6 months. QAC may be used effectively in dental clinics due to the duration of antimicrobial effect and the minimal exposure of chemicals and further studies are needed with large sample size.
ABSTRACT
By facing the era of the 4th industrial revolution, personalized medical services for patients are expanding with the development of information and communications technology. With these changes, digital medical devices have begun to be used to support diagnosis, patient monitoring, and decision-making of diseases, and recently software medical devices for the purpose of preventing, managing, or treating disorders or diseases have become popular. The aim of this article is to understand the current concept and status of Software as a Medical Device (SaMD), which are actively being carried out in the United States, and to find out what fields can be applied in the future. In addition, it intends to find out the Korean domestic policy trends related to smart healthcare and find out the application of digital software as a medical devices that can be used in dental clinic to keep pace with the upcoming changes in the medical field.
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Purpose@#To describe adverse drug reactions (ADRs) to carbamazepine (CBZ) and oxcarbazepine (OXC), including severe cutaneous ADRs, at a tertiary care hospital over a 10-year period. @*Materials and Methods@#The frequency and clinical features of ADRs caused by CBZ and OXC were analyzed using the pharmacovigilance database and spontaneous ADR reporting data of Yonsei University Severance Hospital & Dental Hospital (Seoul, Korea) from January 1, 2010 to January 31, 2020. @*Results@#Among 10419 cases prescribed CBZ and OXC, 204 ADR cases were reported. The incidences of ADRs were 1.8% and 2.2% for CBZ and OXC respectively, with no significant difference (p=0.169). The most common clinical presentations were skin disorders. Female patients had relatively more frequent ADRs than male patients. Although mild skin ADRs were more frequent with OXC, nervous system disorders, general disorders, and hepatobiliary disorders occurred more often with CBZ. There were six reports of severe cutaneous adverse reactions to CBZ, while OXC had none. Both CBZ and OXC caused ADRs at daily doses lower than the recommended initial dose. @*Conclusion@#Due to lower incidence of severe ADRs with OXC than CBZ, we suggest OXC as a first-line prescription.
ABSTRACT
The aim of this study was to investigate the change of microbial contamination levels in the different areas and at the different time points after application of a quaternary ammonium compound (QAC) that has mechanical antimicrobial effect. The microbial contamination levels were measured in three different areas; unit chair handle, spit sink area and hand piece holder at different time points using adenosine triphosphate (ATP) monitoring system and ATP surface test kit. Hand piece holder showed the highest level of microbial contamination. In most of the clinics, QAC significantly reduced the levels of microbial contamination, and maintained antimicrobial activity for 4 to 6 months. QAC may be used effectively in dental clinics due to the duration of antimicrobial effect and the minimal exposure of chemicals and further studies are needed with large sample size.
ABSTRACT
By facing the era of the 4th industrial revolution, personalized medical services for patients are expanding with the development of information and communications technology. With these changes, digital medical devices have begun to be used to support diagnosis, patient monitoring, and decision-making of diseases, and recently software medical devices for the purpose of preventing, managing, or treating disorders or diseases have become popular. The aim of this article is to understand the current concept and status of Software as a Medical Device (SaMD), which are actively being carried out in the United States, and to find out what fields can be applied in the future. In addition, it intends to find out the Korean domestic policy trends related to smart healthcare and find out the application of digital software as a medical devices that can be used in dental clinic to keep pace with the upcoming changes in the medical field.
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To evaluate the side effects of long-term mandibular advancement device (MAD) treatment associated with dental and skeletal changes. The search for clinical trials, retrospective studies and systematic review used PubMed with the following Mesh terms: sleep apnea, mandibular advancement device, and long-term. Patients with obstructive sleep apnea in long-term treatment with MAD may experience side effects due to the protruded jaw position. The side effects reported were reduction in overjet, overbite, development of anterior crossbite, posterior openbite, and deteriorations in apnea-hypopnea index severity and treatment efficacy. Also, the use of MAD may lead to the development of temporomandibular disorders in a small number of patients, but these signs are most likely transient. MAD treatment produces time-related dental and skeletal side effects. Since the side effects are progressive, patients in long-term treatment with MAD must be regularly followed up and the device adjusted.
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Management of migraine, one of common primary headache disorders, involves the diverse strategies non-pharmacological treatment, such as headache diary, lifestyle modification, regular exercise and relaxation, cognitive behavioral therapy and neurostimulation, and pharmacological treatment. Among the treatments, this review described a pharmacologic treatment of migraine, classified into acute and preventive treatment based on the severity and the frequency of headache. It introduced the way to optimize pharmacological treatment and updated the latest treatment for migraine.
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Botulinum toxin (BoNT) injections have been used not only in the field of cosmetic surgery such as forehead and eye wrinkle treatment but also in the treatment of chronic migraine, dystonia, spasticity, temporomandibular disorders (TMD). BoNT injections are the only approved therapies to date for prophylactic treatment of chronic migraine patients. Unlike the previously known paralysis of motor neurons, the mechanism of action for migraine is to block the release of non-cholinergic neurotransmitters such as substance P, CGRP, and glutamate, which are associated with peripheral sensitization and neurogenic inflammation in the sensory nerve, it is hypothesized that the signal is blocked. This review focuses on the analgesic effects of BoNT and suggests the direction for the development of injection methods for chronic migraine patients.
Subject(s)
Humans , Botulinum Toxins , Dystonia , Forehead , Glutamic Acid , Headache Disorders , Migraine Disorders , Motor Neurons , Muscle Spasticity , Neurogenic Inflammation , Neurotransmitter Agents , Paralysis , Substance P , Surgery, Plastic , Temporal Lobe , Temporomandibular Joint DisordersABSTRACT
Headache disorders, one of most common disease in general population, have been developed according to many versions of international classifications. The primary headaches are those in which no consistently identified organic cause can be determined. It is divided into the following categories: (1) migraine, (2) tension-type headache, (3) cluster headache and other trigeminal autonomic cephalalgias, (4) other primary headaches. This review described a diagnosis of primary headache disorders based on International Classification of Headache Disorders (ICHD)-3 beta criteria.
Subject(s)
Classification , Cluster Headache , Dental Clinics , Diagnosis , Headache Disorders , Headache Disorders, Primary , Headache , Migraine Disorders , Temporomandibular Joint Disorders , Tension-Type Headache , Trigeminal Autonomic CephalalgiasABSTRACT
PURPOSE: Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. MATERIALS AND METHODS: A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. RESULTS: Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. CONCLUSION: The results indicate that playing instruments can play a contributory role in the development of TMD.
Subject(s)
Arm , Diagnosis , Mouth , Myalgia , Radiography , Temporomandibular Joint , Temporomandibular Joint Disorders , VolunteersABSTRACT
PURPOSE: Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. MATERIALS AND METHODS: A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. RESULTS: Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. CONCLUSION: The results indicate that playing instruments can play a contributory role in the development of TMD.
Subject(s)
Arm , Diagnosis , Mouth , Myalgia , Radiography , Temporomandibular Joint , Temporomandibular Joint Disorders , VolunteersABSTRACT
We examined the effects of peripherally or centrally administered botulinum neurotoxin type A (BoNT-A) on orofacial inflammatory pain to evaluate the antinociceptive effect of BoNT-A and its underlying mechanisms. The experiments were carried out on male Sprague-Dawley rats. Subcutaneous (3 U/kg) or intracisternal (0.3 or 1 U/kg) administration of BoNT-A significantly inhibited the formalin-induced nociceptive response in the second phase. Both subcutaneous (1 or 3 U/kg) and intracisternal (0.3 or 1 U/kg) injection of BoNT-A increased the latency of head withdrawal response in the complete Freund's adjuvant (CFA)-treated rats. Intracisternal administration of N-methyl-D-aspartate (NMDA) evoked nociceptive behavior via the activation of trigeminal neurons, which was attenuated by the subcutaneous or intracisternal injection of BoNT-A. Intracisternal injection of NMDA up-regulated c-Fos expression in the trigeminal neurons of the medullary dorsal horn. Subcutaneous (3 U/kg) or intracisternal (1 U/kg) administration of BoNT-A significantly reduced the number of c-Fos immunoreactive neurons in the NMDA-treated rats. These results suggest that the central antinociceptive effects the peripherally or centrally administered BoNT-A are mediated by transcytosed BoNT-A or direct inhibition of trigeminal neurons. Our data suggest that central targets of BoNT-A might provide a new therapeutic tool for the treatment of orofacial chronic pain conditions.
Subject(s)
Animals , Humans , Male , Rats , Chronic Pain , Freund's Adjuvant , Head , Horns , N-Methylaspartate , Neurons , Nociception , Rats, Sprague-DawleyABSTRACT
PURPOSE: The aim of this study was to determine the force distribution and pattern of mastication after injection of botulinum toxin type A (BTX-A) into both masseter muscles. The hypothesis to be tested was that the difference between right and left balance of occlusal force diminishes over time following BTX-A injection. MATERIALS AND METHODS: Fifteen patients were submitted to BTX-A injection therapy for subjective masseter hypertrophy. A total of 25 U of BTX-A (50 U in total) was injected into two points located 1 cm apart at the center of the lower one-third of both masseter muscles. All patients were examined using the T-Scan occlusion analysis system before and 4, 8, 12, and 24 weeks after BTX-A injection. RESULTS: A significant change in force balance was found between the right and left sides over time and the difference between the two sides decreased with the time post-injection, reaching a minimum at 12 weeks. Comparison of the force balance between the anterior and posterior occlusions revealed no significant difference at any of the time points. The occlusion and disclusion times (right and left sides) did not differ significantly with time since BTX-A injection. CONCLUSION: A decline in the difference in the clenching force between the left and right sides was found with increasing time up to 12 weeks following BTX-A injection.
Subject(s)
Female , Humans , Male , Bite Force , Botulinum Toxins, Type A/administration & dosage , Hypertrophy/drug therapy , Injections , Masseter Muscle/abnormalities , Neuromuscular Agents/administration & dosageABSTRACT
Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.
Subject(s)
Adult , Female , Humans , Botulinum Toxins, Type A/administration & dosage , Injections , Migraine Disorders/drug therapyABSTRACT
Subject(s)
Female , Humans , Deglutition Disorders , Head , Ligaments , Neck , Ossification, Heterotopic , Pain, Referred , Pharynx , Sensation , Temporal BoneABSTRACT
PURPOSE: To report a case of high dose steroid-responsive Purtscher's retinopathy which was developed after operation for diaphragmatic laceration sustained in motorcycle accident. CASE SUMMARY: A 68-year-old man came to our hospital with complaining of decreased visual acuity in the right eye after diaphragmatic laceration operation. Best corrected visual acuity was 0.1 in the right eye. Anterior segment was nonspecific. However, afferent pupillary defect was observed. Superficial intraretinal hemorrhage, numerous cotton-wool spots, peripapillary hemorrhage, and macular edema were detected on fundus examination. Fluorescein angiography revealed capillary nonperfusion and fluorescein filling defect due to retinal hemorrhage in arteriovenous phase and fluorescein leakage from the macula and capillary nonperfusion area in the late venous phase. Accordingly, Purtscher's retinopathy was diagnosed and the patient was observed without specific treatment. After 2 weeks of observation, symptoms and fundus findings were not changed. High-dose steroid therapy was begun with injection of one gram of methylprednisone for three days, switched to oral prednisolone, and then slowly tapered in period of 3 weeks. 7 days after the treatment, visual acuity was improved to 0.2 in the right eye but afferent pupillary defect was still observed. Cotton-wool spots slightly decreased, peripapillary hemorrhage was absorbed but macular edema was remained. 14 days after the treatment, visual acuity greatly improved to 0.63 and afferent pupillary defect was not observed. Cotton-wool spots and macular edema were decreased but fluoroscein leakage from capillary nonperfusion area was remained. CONCLUSIONS: In the case of Purtscher's retinopathy, high-dose steroid therapy can be a useful management method for the improvement of visual acuity and other symptoms.