Treatment Outcome and Prognosis of the Outpatients with Orofacial Pain

구강안면통증 환자의 치료결과와 예후에 관한 연구

  • Choi, Sea-Hun (Department of Oral Medicine, School of Dentistry, Dankook University) ;
  • Kim, Ki-Suk (Department of Oral Medicine, School of Dentistry, Dankook University) ;
  • Kim, Mee-Eun (Department of Oral Medicine, School of Dentistry, Dankook University) ;
  • Lee, Dong-Ju (Department of Oral Medicine, School of Dentistry, Dankook University) ;
  • Jin, Sang-Bae (Department of Oral Medicine, College of Dentistry, Kyung-Hee University)
  • 최세헌 (단국대학교 치과대학 구강내과학교실) ;
  • 김기석 (단국대학교 치과대학 구강내과학교실) ;
  • 김미은 (단국대학교 치과대학 구강내과학교실) ;
  • 이동주 (단국대학교 치과대학 구강내과학교실) ;
  • 진상배 (경희대학교 치과대학 구강내과학교실)
  • Published : 2006.06.30

Abstract

The purpose of this study was to evaluate treatment outcome and prognosis of the patients with orofacial pain disorders who visited for treatment in the Department of Oral Medicine, Dankook University Dental Hospital from January 2002 to December 2004. Orofacial pain disorders were categorized into TMD(myogenous, arthrogenous and muscle-joint combined TMDs), neuropathic pain disorder, oral soft tissue disease and complex condition simultaneously having more and two aforementioned categories and treatment period, method and treatment outcome were evaluated. The results of this study were as follows; 1. Average longevity of treatment period was the longest in the neuropathic pain, followed by soft tissue disease, complex conditions, arthrogenous TMD, muscle-joint combined TMD and myogenous TMD in order. 2. When treatment methods were largely categorized into pharmacologic, physical and oral appliance therapy, pharmacologic therapy was used the most frequently for the patients with neuropathic pain or oral soft tissue diseases, oral appliance therapy for those with arthrogenous TMD and physical therapy for those with myogenous TMD. 3. Of physical therapeutic methods used in our clinic, EAST and microwave was employed the most frequently in the patients with myogenous TMD, ultrasound for those with arthogenous TMD and LLLT for those with neuropathic pain or oral soft tissue disease. 4. In comparison with change of pain after treatment, there existed a tendency that pain from neuropathic pain disorders persisted while pain from TMD was getting better or totally disappeared. 5. Concerning the change of mouth opening range in the TMD subgroups, there was no significant difference among the subgroups but significant difference existed among opening ranges, indicating comfortable maximum mouth opening increased the most following treatment. Improvement of active range of mouth opening was the most considerable in those with disc displacement without reduction. It can be said on the basis of the findings from this study that various treatments currently used for the orofacial pain showed good results with TMD in regards with pain control and improvement of function, suggestive of favorable prognosis, while neuropathic pain or soft tissue disease was the clinical conditions difficult to resolve, requiring a long and persistent treatment.

본 연구는 단국대학교 치과대학 부속병원 구강내과에 내원한 측두하악장애 환자를 포함한 구강안면동통 환자들을 대상으로 치료의 결과와 예후를 평가하기 위하여, 2002년 1월부터 2004년 12월까지 3년간 (치아질환을 제외한) 구강안면동통 환자 6300명 중에서 진료기록부 상에서 경과기록을 확인할 수 있는 환자들을, 측두하악장애, 신경병성동통장애, 연조직질환 및 이 중 둘 이상을 질환을 동시에 가지고 있는 복합질환으로 나누어 치료기간, 치료유형 및 치료효과를 비교하여 다음의 결과를 얻었다. 1. 평균 진료기간은 신경병성 동통장애에서 가장 길었고 연조직질환, 복합 질환, 관절장애, 근육-관절 복합장애, 근육장애의 순이었다. 2. 사용된 치료방법을 비교하면 약물요법은 연조직질환과 신경병성 동통장애에서, 장치요법은 관절장애군에서, 물리치료는 근육장애군에서 사용빈도가 높았다. 3. 진단분류별 물리치료의 사용경향은 근육장애군은 EAST와 초단파요법의 사용빈도가 높았고, 관절장애군은 초음파 치료, 신경병성 동통 장애와 연조직 질환은 저출력 레이저 요법이 많이 사용되었다. 4. 통증에 대한 치료결과는 통증이 지속되는 경향이 신경병성 동통장애에서 가장 높았으며, 완화되거나 완전 소실되는 경향은 측두하악장애에서 높았다. 5. 측두하악장애 환자에서 근육장애, 정복성 관절원판장애, 비정복성 관절원판 장애 및 근육-관절 복합장애 세분하여 치료 후 개구량의 변화를 조사하였을 때는 진단군 간에 유의한 차이를 볼 수 없었으나 개구량 측정방법간에는 무통성 최대개구량이 치료 후 가장 증가하였고, 환자 스스로가 벌리는 능동적 최대개구량은 비정복성관절원판장애에서 가장 증가하였다. 이상의 결과로 볼 때, 구강안면통증 영역에서 현재 시행하고 있는 치료법들은 측두하악장애에서는 동통조절 및 기능개선에 좋은 결과를 보여주고 있으므로 그 예후가 좋은 반면, 연조직질환이나 신경계 질환 같은 기타의 구강안면통증은 길고 지속적인 치료를 요구하는 어려운 질환이라고 할 수 있겠다.

Keywords

References

  1. Okeson JP. Orofacial pain: Guidelines for assessment, classification, and management/ the AAOP 1996, Quintessence Publishing Co, Inc
  2. Zakrzewska JM, Harrison SD. Pain research and clinical management Vol.14 Assessment and management of orofacial pain. 2002 Elsevier Amsterdam
  3. Okeson JP. Bell's Orofacial Pain. 6th ed. 2004, Quintessence Publishing Co., Inc
  4. Kreisberg MK. Tricyclic antidepressants: Analgesic effect and indications in orofacial pain. J Craniomandib Disord Facial Oral Pain. 1988;2:171-177
  5. Brown TS, Bottomley WK. The utilization and mechanism of action of tricyclic antidepressants in the treatment of chronic facial pain: A review of the literature. Anesth Prog 1990;37:223-239
  6. Sharav Y, Singer E, Schmidt E, Dionne RA, Dubner R. The analgesic effect of amitriptyline on chronic facial pain. Pain. 1987;31:199-209 https://doi.org/10.1016/0304-3959(87)90036-4
  7. Solberg WK, Clark GT, Rugh JD. Nocturnal electromyographic evaluation of bruxism patients undergoing short term splint therapy. J Oral Rehabil 1975; 2:215-223 https://doi.org/10.1111/j.1365-2842.1975.tb00915.x
  8. Clark GT, Beemsterboer PL, Rugh JD. Nocturnal masseter hyperactivity and the symptoms of masticatory dysfunction. J Oral Rehabil 1981;8:279-286 https://doi.org/10.1111/j.1365-2842.1981.tb00502.x
  9. Okeson JP, Kemper JT, Moody PM. A study of the use of occlusion splints in the treatment of acute and chronic patients with craniomandibular disorders. J Prosthet Dent. 1982;48:708-712 https://doi.org/10.1016/S0022-3913(82)80034-6
  10. Clark GT. A critical evaluation of orthopedic interocclusal appliance therapy: Design, theory, and overall effectiveness. J Am Dent Assoc 1984;108: 359-364 https://doi.org/10.14219/jada.archive.1984.0010
  11. Okeson JP. Management of temporomandibular disorders and occlusion. 5th ed. Elsevier Pet, Ltd
  12. 정성창, 김영구 외. 구강안면동통과 측두하악장애. 신흥 인터내셔날, 서울, 1996
  13. Yap AU, Tan KB, Chua EK, Tan HH. Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent 2002;88:479-484 https://doi.org/10.1067/mpr.2002.129375
  14. Kleinknecht RA, Mahoney ER, Alexander LD. Psychosocial and demographic correlates of temporomandiblar disorders and related symptoms: An assessment of community and clinical findings. Pain 1987;29:313-324 https://doi.org/10.1016/0304-3959(87)90046-7
  15. Serpell MG. Neuropathic pain study group. Gabapentin in neuropathic pain syndromes: a randomized, double-blind, placebo-controlled trial. Pain 2002;99:557-566 https://doi.org/10.1016/S0304-3959(02)00255-5
  16. Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus : a randomized controlled trial. J Am Med Assoc. 1998;280:1831-1836 https://doi.org/10.1001/jama.280.21.1831
  17. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. J Am Med Assoc.1998;280:1837-1842 https://doi.org/10.1001/jama.280.21.1837
  18. Rice ASC, Maton S. Postherpetic neuralgia study group. Gabapentin in postherpetic neuralgia: a randomized double-blind placebo-controlled study. Pain. 2001;94:215-224 https://doi.org/10.1016/S0304-3959(01)00407-9
  19. McCluskey A, Currer BA, Sayeed I. The efficacy of 5% lidocaine-prilocaine (EMLA) cream on pain during intravenous injection of propofol. Anesth Analg 2003;97:713-714
  20. Epstein JB, Marcoe JH. Topical application of capsaicin for treatment of oral neuropathic pain and trigeminal neuralgia. Oral Surg Oral Med Oral Pathol 1994;77:135-140 https://doi.org/10.1016/0030-4220(94)90275-5
  21. Abergel RP, lyons RF, Castel JC, Dwyer RM, Unitto J. Biostimulation of wound healing by laser: experimental approaches in animal models and in fibroblast cultures. J Dermatol Surg Oncol 1987;13:127-133 https://doi.org/10.1111/j.1524-4725.1987.tb00510.x
  22. Lowe AS, Walker MD, O'Byrne M, Baxter GD, Hirst DG. Effect of low intensity monochromatic light therapy (890nm) on a radiation-impaired, wound healing model in murine skin. Lasers Surg Med. 1998;23:291-298 https://doi.org/10.1002/(SICI)1096-9101(1998)23:5<291::AID-LSM9>3.0.CO;2-P
  23. Mester E, Mester AF, Mester A. The biomedical effects of laser application. Lasers Surg Med. 1985;5:31-39 https://doi.org/10.1002/lsm.1900050105
  24. Karu T, Kalendo G, Lethokov V, Lobko V. Biostimulation of HeLa cells by low-intensity visible light II. Stimulation of DNA and RNA synthesis in a wide spectral range. Nuevo Cimento 3rd ed. pp 309-318, 1984
  25. Zinman LH, New KT, Ngo M, Gogov S, Ng ET, Bril V. Low-intensity laser therapy for painful symptoms of diabetic sensorimotor polyneuropathy. Diabetic care 2004;27:921-924 https://doi.org/10.2337/diacare.27.4.921
  26. Eckerdal A, Bastian HL. Can low reactive-level laser therapy be used in the treatment of neurogenic facial pain? A double-blind, placebo controlled investigation of patients with trigeminal neuralgia. Laser therapy. 1996;8:247-252 https://doi.org/10.5978/islsm.8.247
  27. Khullar SM, Emami B, Westermark A, Haanaes HR. Effect of low-level laser treatment on neurosensory deficits subsequent to saggittal split ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:132-138 https://doi.org/10.1016/S1079-2104(96)80215-0
  28. Cho SH, Park JS, Ko MY. Immediate effect of low level laser therapy in the temporomandibular joint disorders. Korean J Oral Med 2003;28:281-294
  29. 김선영, 박준상. 저출력레이저를 이용한 교근 및 승모근 발통점의 치료에 관한 연구. 대한구강내과학회지 1996;21:25-36
  30. Kreiner M, Betancor E, Clark GT. Occlusal stabilization appliances. Evidence of their efficacy. Am J Dent Assoc 2001;132:770-777 https://doi.org/10.14219/jada.archive.2001.0274
  31. Dao TT, Lavigne GJ. Oral splints: the crutches for temporomandibular disorders and bruxism? Crit Rev Oral Biol Med 1998;9:345-361 https://doi.org/10.1177/10454411980090030701
  32. Kurita H. Kurashina K, Kotani A. Clinical effect of full coverage occlusal splint therapy for specific temporomandibular disorder conditions and symptoms. J Prosthet Dent 1997;78:506-510 https://doi.org/10.1016/S0022-3913(97)70067-2
  33. dos Santos JD Jr, de Rijk WG. Vectorial analysis of the equilibrium of forces transmitted to TMJ and occlusal biteplane splints. J Oral Rehabil 1995;22:301-310 https://doi.org/10.1111/j.1365-2842.1995.tb00090.x
  34. Esposito CJ, Veal SJ, Farman AG. Alleviation of myofascial pain with ultrasonic therapy. J Prosthet Dent 1984;51:106-108 https://doi.org/10.1016/S0022-3913(84)80115-8
  35. Kleinkort JA, Wood F. Phonophoresis with 1 percent versus 10 percent hydrocortisone. Phys Ther 1975;55:1320-1324 https://doi.org/10.1093/ptj/55.12.1320
  36. Shin SM, Choi JK. Effect of indomethacin phonophoresis on the relief of temporomandibular joint pain. Cranio. 1997;15:345-348 https://doi.org/10.1080/08869634.1997.11746030
  37. Lundh H, Westesson PL, Eriksson L, Brooks SL. Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment. Oral Surg Oral Med Oral Pathol 1992;73:655-658 https://doi.org/10.1016/0030-4220(92)90003-9
  38. Chung SC, Kim HS. The effect of the stabilization splint on the TMJ closed lock. J Craniomandib Pract 1993;11:95-101
  39. Kai S, Kai H, Tabata O, Shiratsuchi Y, Ohishi M. Long-term outcomes of nonsurgical treatment in nonreducing anteriorly displaced disk of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:258-267 https://doi.org/10.1016/S1079-2104(98)90005-1
  40. Kurita K, Westesson PL, Yuasa H, Toyama M, Machida J, Ogi N. Natural course of untreated symptomatic temporomandibular joint disc displacement without reduction. J Dent Res 1998;77:361-365 https://doi.org/10.1177/00220345980770020401