Hye-Kyoung Kim

Clinical Epidemiology for Elderly Patients of Oral Medicine Clinic

우리 사회의 급속한 고령화로 인해 노인 인구는 이미 사회적으로나 의료계에 중요 연령집단으로 자리매김했으며 그 중요도는 향후 더욱 증가할 것이다. 특히 만성의 비치성 구강안면통증질환과 구강건조증, 하악운동이상증, 구강연조직질환 등을 주로 다루는 구강내과의 특성상 노인 환자들의 비중이 증가할 것이나 구강내과에 내원하는 노인 환자에 대한 연구는 부족하다. 그러므로 본 연구는 지난 10년 사이 치과대학병원에 내원하는 환자의 연령별 분포의 변화를 조사하고 특히 구강내과에 내원하는 노인 환자의 다양한 임상 특성을 조사하기 위하여 시행하였다. 본 연구는 2001년과 2011년의 단국대학교 치과대학 부속 치과병원의 초진환자에 대한 병원전산자료와 2011년 구강내과 환자의 챠트와 설문지 자료를 이용하여 후향적으로 시행되었다. 본 연구 결과, 지난 10년 사이에 치과병원과 구강내과의 노인환자 비율이 뚜렷하게 증가하였으며, 특히 구강내과의 노인환자는 2배 이상 증가하여 전체 치과병원 환자의 증가 (1.6배) 보다 뚜렷하였다 (p=0.000). 구강내과에 내원하는 18세 이상의 성인 환자의 13.5%는 노인환자였으며(남:녀=1:2.1), 이들 중 약 83%가 하나 이상의 전신질환을 가지고 있었다. 진단별로 볼 때 노인 환자들도 18～64세 사이의 일반 성인 환자들과 마찬가지로 턱관절장애의 비율이 가장 높았지만, 구강연조직질환, 구강건조증, 구강작열감증후군, 하악운동이상증의 발생이 성인 환자에 비해 많았다(0=0.000). 통증과 일상생활제한, 우울과 불안 역시 노인 환자들이 높았다 (p 구강내과에 내원하는 노인환자들은 재발성 혹은 만성의 질환이 많고, 다양한 전신질환과 다수의 약물복용 등, 의사소통의 제한 등으로 인해 질병의 평가와 치료가 더욱 복잡해지고 제한되기 때문에 증가하는 노인환자의 효율적인 관리를 위해 평가법의 개선이나 특화된 관리가 필요하다.

Influence of test site and baseline temperature on orofacial thermal thresholds.

AIMS To investigate thermal thresholds of selected orofacial sites, determine if there is a relationship between thermal thresholds at each site, and analyze the influence of two different baseline temperatures on thermal thresholds at the tongue tip. METHODS Thirty healthy men (mean age, 26 years) participated. Cold detection (CDT), warm detection (WDT), cold pain (CPT), and heat pain (HPT) thresholds were measured bilaterally at five orofacial sites (mentum, lower lip, cheek, forehead, and tongue tip). Relations between thermal thresholds at each test site were assessed. Thermal sensitivity of the tongue tip was compared at two different baseline temperatures (32°C and 36°C). One-way ANOVA, Turkey post-hoc test, paired t test and Pearsons correlation were used for statistical analyses. RESULTS There was a significant difference for CDT, WDT, and HPT between test sites (ANOVA, P < .001) but no significant difference for CPT (P = .634). Subjects sensitive to cooling were sensitive to warming at the mentum (r = 0.379), tongue tip (r = 0.610), and cheek (r = 0.431) but not at the other test sites. There was a strong negative correlation between CPT and HPT at all test sites. There was no significant difference for CDT and WDT at the baseline temperature of 36°C (paired t test, P = .660), but there was a significant difference at the baseline temperature of 32°C (P < .001). There were no significant differences between CPTs at the two different baseline temperatures (P = .773), while a significant difference existed between HPTs (P = .034). CONCLUSION Thermal thresholds varied between the orofacial test sites, and baseline temperature affected thermal sensitivity of the tongue. Subjects who were relatively sensitive to cold tended to be more sensitive to heat.

Thermal Perception as a Key Factor for Assessing Effects of Trigeminal Nerve Injury

AIMS To conduct a functional examination using multimodal exploration of a sample of patients with iatrogenic trigeminal nerve injury to understand the underlying mechanisms of neuropathic pain following trigeminal nerve injury. METHODS Subjective and objective symptoms and responses to thermal and electrical quantitative sensory testing (QST) were evaluated in 85 patients with unilateral trigeminal nerve injury. Objective symptoms were measured by seven clinical sensory tests. Thermal QST included cold detection threshold (CDT), warm detection threshold (WDT), and heat pain threshold (HPT). Electrical current perception threshold was performed with electrical stimuli of 2,000, 250, and 5 Hz. The time since injury was included as a possible independent variable. The data were analyzed using chi-square test, independent t test, Mann Whitney U test, one-way analysis of variance (ANOVA), and Kruskal-Wallis test. Further analyses with Pearson correlation analysis, Spearman rank correlation analysis, and cluster analysis were applied. RESULTS Unlike objective symptoms, thermal and electrical QST values and subjective symptoms did not improve in patients with an old injury. Thermal QST, particularly WDT, showed the highest positive correlation with subjective symptoms in all tests. Cluster analysis of the thermal QST values identified three subgroups: cluster 1, which was characterized by prominent cold and warm hypoesthesia; cluster 2, which presented elevated WDT; and cluster 3, which showed the smallest thermal differences for all thermal variables but had the highest proportion of neuropathic pain. CONCLUSION These findings have demonstrated that thermal QST is a suitable tool for evaluating and characterizing the sensory effects of trigeminal nerve injury. Three subgroups with different thermosensory profiles showed that the less the damage, the more neuropathic pain occurs. The loss of warm perception in particular might play a pivotal role in the chronicity and severity of subjective sensory symptoms.

Two-point discrimination values vary depending on test site, sex and test modality in the orofacial region: a preliminary study

Abstract The two-point discrimination (TPD) test is one of the most commonly used neurosensory tests to assess mechanoperception in the clinical settings. While there have been numerous studies of functional sensibility of the hand using TPD test, there have been relatively not enough reports on TPD in the orofacial region. Objective The aims of the present study were to determine the normal values of TPD in the six trigeminal sites (the forehead, cheek, mentum, upper lip, lower lip, and the tongue tip) and to investigate the effect of the site, sex, and test modality on the TPD perception. Material and Methods Forty healthy volunteers consisting of age-matched men (20) and women (20) with a mean age of 27.1 years were recruited. One examiner performed the TPD test using a simple hand-operated device, i.e., by drawing compass with a blunt or sharp-pointed tip. The static TPD with a blunt-pointed tip (STPDB), moving TPD with a blunt-pointed tip (MTPDB), and static TPD with a sharp-pointed tip (STPDS) were measured. The predictors were the site, sex, and test modality, and the outcome variable was the TPD value. Three-way ANOVA was used for statistics. Results The analysis showed a significant effect of the site, sex and test modality on the TPD values. Significant differences between the test sites were observed with the descending order from the forehead and cheek>mentum>upper lip and lower lip>tongue tip and index finger. Women showed lower TPD values than those of men. The STPDS measurements were consistently lower than those of the STPDB and MTPDB. Conclusions The normal values of TPD in this study suggest that the cheek and forehead were less sensitive than other regions evaluated and women were more sensitive than men. The STPDS was the most sensitive test modality.

Comparison of unpleasant and pain thresholds of thermal stimuli in the orofacial regions: a psychophysical study using quantitative sensory testing in healthy young men

Abstract Purpose/Aim: To gain a better understanding of the psychophysics of thermal pain perception in a clinical setting, this study investigated whether thermal thresholds of unpleasantness are different from pain thresholds of cold and heat stimuli. Of particular interest was the relationship between unpleasantness and pain thresholds for cold vs heat stimuli. Material and methods: Thirty healthy male volunteers (mean age 26.1 years, range 23 to 32 years) participated. Thermal detection, cold pain (CPT) and heat pain (HPT) thresholds were measured at 5 trigeminal sites by the method of limits using quantitative sensory testing (QST), followed by cold unpleasant (CUT) and heat unpleasant (HUT) thresholds. Results: The temperatures at which individuals first reported thermal sensations as unpleasant or painful substantially differed among subjects. CUT exhibited a higher mean value with less variability than CPT, and HUT presented a lower mean than HPT (p < .001). As with CPT, CUT did not show any significant difference between the test sites. On the other hand, HUT, like HPT, exhibited site differences (p < .001). There was moderate correlation between CUT and CPT, whereas HUT and HPT were strongly correlated. The relationship between unpleasant and pain thresholds of cold vs heat stimuli was significantly different even when controlling for test site variability (p < .001). Conclusion: These findings indicate that unpleasant and pain thresholds to thermal stimuli differ in healthy young men. Of particular note is the distinct relationship of unpleasant and pain thresholds of cold vs heat stimuli, revealing the thermal difference in temperature transition from unpleasantness to pain.

Pain Catastrophizing Mediates the Effects of Psychological Distress on Pain Interference in Patients with Orofacial Pain: A Cross-Sectional Study

AIMS To investigate whether pain catastrophizing has not only direct effects as a predictor of pain-related interference but also indirect effects as a mediator in the relationship between psychological distress and pain interference and to examine the mediating roles of subtypes of catastrophizing (magnification, rumination, and helplessness) between psychological distress and interference. METHODS This retrospective study included 815 patients with orofacial pain aged 18 to 81 years. All participants completed a set of self-administered questionnaires concerning pain interference (Brief Pain Inventory), psychological distress (Symptom Checklist-90-Revised), and pain catastrophizing (Pain Catastrophizing Scale) at the first consultation. The associations between these three variables were calculated using mediation path analysis. RESULTS Pain catastrophizing predicted pain interference. In addition, 34% of the variance in pain interference attributable to psychological distress was mediated by catastrophizing when controlling for pain duration and severity. The greatest portion of the mediating effect of catastrophizing was attributable to the helplessness component. CONCLUSION Within the limitations of cross-sectional studies, this study demonstrated that pain catastrophizing mediates the effects of psychological distress on pain interference in patients with orofacial pain. Most of the mediating effects were attributable to the helplessness component of pain catastrophizing. Cognitive behavioral therapy targeting pain catastrophizing, specifically helplessness, could potentially reduce pain-related disability in orofacial pain patients.

Risk factors for the efficacy of oral appliance for treating obstructive sleep apnea: A preliminary study

Abstract Objective: To identify potential risk factors of response to oral appliance in patients with obstructive sleep apnea (OSA). Methods: Fifteen OSA patients were enrolled. Clinical characteristics, cephalometric measurements, and the results of home sleep testing were retrospectively obtained at baseline, and a sleep test was done again at the end of treatment. Results: Twelve subjects were responders and three were non-responders. The diastolic blood pressure, minimum pulse rate, SNA (Angle between sella-nasion and nasion-A point), ANB (Anteroposterior maxilla/mandible discrepancy), and facial convexity of non-responders was higher than those of responders. Unlike AHI, non-responders showed a lower lowest oxygen saturation (%) than responders. Discussion: Elevated diastolic pressure and minimal pulse rate, higher skeletal convexity and lowered lowest oxygen saturation might be risk factors to oral appliance efficacy in the OSA patients. More research in a large sample is needed to verify the results of the current study.

Conservative management of dislocated temporomandibular joints: A case report

Dislocation of the temporomandibular joint (TMJ) occurs when the mandibular condylar head is displaced completely out of the glenoid fossa and cannot be reduced by the patient. The occurrence of bilateral anterior dislocation is the most common. Dislocations can be classified into three types in terms of duration and frequency of dislocation, i.e., acute, chronic and recurrent. There are various treatment modalities for dislocation from conservative try to surgical intervention. The selection for the appropriate modality mainly depends on the types of dislocation as previously stated. The authors report three cases of dislocation with different treatment modalities according to the duration of dislocation. In particular, we tried prosthetic approach instead of surgical intervention in the patient with chronic dislocation.