교정과에 내원한 신환의 두개하악장애의 평가

Abstract

[한글]

두개하악장애의 최근의 역학연구는 진단학적 분류, 진단기준, 질병정도의 다각적 측정방법을 확립하고 이들을 진단과 치료에 활용하므로서 많은 발전을 이루었다. 이와같이 전세계적으로 진단학적 분류에 의한 역학조사가 활발히 이루어지는데 반해 국내에서의 연구

는 아직 미흡한 실정이다. 이에 교정과에 내원한 신환을 대상으로 Helkimo지수와 CMI(Craniomandibular index), RDC(Research Diagnostic Criteria)를 이용하여 교정치료를 필요로하는 환자군에서의 두개하악장애의 정도와 그 기여인자와의 상관관계 분석을 통하여 다음과 같은 결론을 얻었다.

1. RDC(Research Diagnostic Criteria)에 의한 환자 스스로 인지하고 있는 안면 및 두부의 만성통증 및 기능장애(Chronic pain severity and Disability)는 전체조사대상의 13.3%였고 우울증상(Depression)을 보인 경우는 34.4%였다.

2. 악습관(Parafunction)의 빈도는 이같이(16.7%), 수면시의 나쁜 머리자세(6.7%),이악물기(5.6%)의 순으로 나타났으며 한가지 이상의 악습관을 갖는 경우는 조사대상의 24.4%였다.

3. RDC에 의한 진단분류에서 정복성 관절원판 전위(Disc displacement with reduction-15.6%), 개구제한이 없는 비정복성 관절원판 전위(Disc displacement without reduction without limited opening-7.7%), 근막동통(Myofascial pain-6.6%), 개구제한이 있는 근막동통(Myofascial pain with limited opening-1.1%), 개구제한이 있는 비정복성 관절원판 전위(Disc displacement without reduction with limited opening-1.1%)의 순으로 나타났다.

4. 본 연구대상의 평균 HDI(Helkimo dysfunction index)는 평균 3.29로서 약간의 기능장애 범주(mild drysfunction)에 속하였고 CMI(Craniomandibular index)는 평균 0.11의 수치를 나타내었다.

5. CMI중 각 항목의 유병율은 CMI-Dl(악관절 기능장애정도)에서는 하악운동의 장애정도(MM-84.4%), 악관절 잡음(TN-44.4%), 악관절낭 촉진시의 양성반응정도(TP-13.3%)의 순으로 나타났으며 CMI-Pl(근육 촉진시의 장애정도)에서는 구외근육의 장애정도(EP-47.8%), 경부근육의 장애정도(NP-10%), 구내근육의 장애정도(IP-6.7%)의 순으로 나타났다.

6. 두개하악장애지수(HDI, CMI)와 교합장애지수(HOI-Helkimo occlusion index, ODI-Occlusal dysfunction index)와의 비교에서 뿐만 아니라 두개하악장애지수와 악습관의 비교에서도 각각 연관성이 있는 것으로 나타났으며 악관절 기능장애지수(CMI-Dl)와 교합장애

지수가 더 연관성이 있는 것으로 나타났고 근육장애지수(CMI-Pl)의 경우 악습관과 더 연관성이 있었다.(P<0.05).

EVALUATION OF CRANIOMANDIBULAR DISORDERS IN NEW PATIENTS WHO VISITED DEPARTMENT OF

ORTHODONTICS

Yong-Hoon Kim

Department of Dentistry, the Graduate School, Yonsei University

(Directed by professor Won-You Lee, D.D.S., M.S.D., Ph.D.)

Recent epidemiologic studies on craniomandibular disorders have been greatly

improved by estabilishing diagnostic classification, diagnostic criteria, and

various methods of measuring severity of disease, and putting them to actual usuage

in diagnosis and treatment. Etiologic researches according to diagnostic

classification have been actively carried out worts-widely; However, in Korea, such

studies seem to be somewhat insufficent. The sample group for this study consists

patients who visited dept. of orthodontics in Yonsei University. Dental hospital,

and using Helkimo index, Craniomandibular index, and Research Diagnostic Criteria,

correlations between severity of craniomandibular disorders and their contributing

factors in patients who need orthodontic treatment were observed. The following

results were obtained.

1. According to RDC, 13.3% of the sample group had chronic pain severity and

disability of craniofacial region and 34.4% showed depression.

2. The most frequently encountered habits were observed in order of

brutism(16.7%), malposition of head in sleeping(6.7%), and clenching(5.6%), 24.4%

of the sample group possessed more than one parafunction.

3. According to RDC, craniomandibular disorders were observed in the order of

disc displacement with reduction(15.6%), disc displacement without reduction,

without limited opening(7.7%), myofascial pain(6.6%), myofascial pain with limited

opening(1.1%), and disc displacement without reduction with limited opening(1.1%).

4. Average HDI of this study was 3.29, which belongs to the mild dysfunction

range; CMI was 0.11 in average.

5. According to CMI-Dl, prevalance of each disorder were observed in order of

mandibular movement dysfunction(MM-84.4%), TMJ noise(TN-44.4%), and positive

response on palpation of TMJ capsule(TP-13.3%). According to CMI-Pl, they were

observed in order of extraoral muscle disturbance (EP-47.8%), cervical muscle

disturbance(IP-6.7), and intraoral muscle disturbance(IP-6.7%).

6. Correlation were noticed not only in the comparision of craniomandibular

index(HDI, CMI) and occlusal dysfunction index(HOI, ODI) but also of

craniomandibular disorder index and parafunction.

CMI-Dl and occlusal dysfunction index seemed to have more correlation and CMI-PI

was more closely related to parafunction.(p 0.05).

[영문]

Recent epidemiologic studies on craniomandibular disorders have been greatly improved by estabilishing diagnostic classification, diagnostic criteria, and various methods of measuring severity of disease, and putting them to actual usuage in diagnosis and treatment. Etiologic researches according to diagnostic

classification have been actively carried out worts-widely; However, in Korea, such studies seem to be somewhat insufficent. The sample group for this study consists patients who visited dept. of orthodontics in Yonsei University. Dental hospital,

and using Helkimo index, Craniomandibular index, and Research Diagnostic Criteria, correlations between severity of craniomandibular disorders and their contributing factors in patients who need orthodontic treatment were observed. The following results were obtained.

1. According to RDC, 13.3% of the sample group had chronic pain severity and disability of craniofacial region and 34.4% showed depression.

2. The most frequently encountered habits were observed in order of brutism(16.7%), malposition of head in sleeping(6.7%), and clenching(5.6%), 24.4% of the sample group possessed more than one parafunction.

3. According to RDC, craniomandibular disorders were observed in the order of disc displacement with reduction(15.6%), disc displacement without reduction, without limited opening(7.7%), myofascial pain(6.6%), myofascial pain with limited opening(1.1%), and disc displacement without reduction with limited opening(1.1%).

4. Average HDI of this study was 3.29, which belongs to the mild dysfunction range; CMI was 0.11 in average.

5. According to CMI-Dl, prevalance of each disorder were observed in order of mandibular movement dysfunction(MM-84.4%), TMJ noise(TN-44.4%), and positive response on palpation of TMJ capsule(TP-13.3%). According to CMI-Pl, they were observed in order of extraoral muscle disturbance (EP-47.8%), cervical muscle

disturbance(IP-6.7), and intraoral muscle disturbance(IP-6.7%).

6. Correlation were noticed not only in the comparision of craniomandibular index(HDI, CMI) and occlusal dysfunction index(HOI, ODI) but also of craniomandibular disorder index and parafunction.

CMI-Dl and occlusal dysfunction index seemed to have more correlation and CMI-PI was more closely related to parafunction.(p 0.05).