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Are Smokers More Susceptible to Temporomandibular Disorders?

Journal of Oral Medicine and Pain.2024;49(4):79-82. doi:10.14476/jomp.2024.49.4.79

This study explores the complex relationship between smoking and temporomandibular disorders (TMDs), highlighting mechanisms such as inflammation, muscle tension, impaired healing, and altered pain perception. Smoking’s impact on circulation and stress responses may increase susceptibility to TMDs and hinder recovery. While nicotine offers short-term relief, its long-term effects exacerbate pain sensitivity and anxiety. This research underscores the need for further investigation into how lifetime smoking behavior influences TMD risk and chronicity, providing insights for improved management of TMDs in smokers.

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Invasive Squamous Cell Carcinoma Arising in the Gingival Oral Lichen Planus: Importance of Oral Hygiene

Young Joo SHIM

Journal of Oral Medicine and Pain.2024;49(4):153-157. doi:10.14476/jomp.2024.49.4.153

Oral lichen planus (OLP) is one of the oral potentially malignant disorders. Although malignant transformation (MT) of OLP is relatively uncommon, periodic examinations are advisable to monitor for any changes related to MT. This case report presents a case of squamous cell carcinoma arising in a patient with gingival OLP and poor oral hygiene.The lesion was initially considered to be gingival swelling resulting from inadequate dental plaque control. However, it eventually transformed into oral squamous cell carcinoma.This case study discusses the risk factors for carcinogenesis and the importance of periodic regular observation.

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Considerations for Chronic Pain Management Based on Sex Differences: A Narrative Review

Hye-Ji PARK

Journal of Oral Medicine and Pain.2024;49(4):83-90. doi:10.14476/jomp.2024.49.4.83

Sex differences in chronic pain are well-documented and have significant implications for both research and clinical practice. This review explores three key aspects: the epidemiology and characteristics of chronic pain, the underlying mechanisms driving sex differences, and tailored approaches to pain management. Biological factors, including hormonal, genetic, and neuroimmune contributions, interact with psychosocial and cultural influences to shape pain perception and response to treatment in males and females.Furthermore, sex-specific disparities in preclinical and clinical research continue to challenge the generalizability of findings, underscoring the need for balanced study designs. Evidence suggests that personalized pain management strategies, integrating sexspecific pharmacological and non-pharmacological interventions, can enhance treatment outcomes and quality of life. By addressing these disparities and adopting sex-informed practices, clinicians can better meet the needs of diverse patient populations. This review aims to deepen understanding and promote equitable, effective management of chronic pain across sexes.

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Malignant Transformation from Oral Epithelial Dysplasia: Two Case Reports on the Ventral Tongue

Yeonseo KIM ; Hee-Kyung PARK

Journal of Oral Medicine and Pain.2024;49(4):164-168. doi:10.14476/jomp.2024.49.4.164

Tongue cancer is one of the most prevalent malignancies in oral and maxillofacial area.Early diagnosis is crucial for improved clinical outcome. Regarding malignant transfor mation, it is important to understand the concept of oral potentially malignant disorders and oral epithelial dysplasia (OED). We present two cases of oral squamous cell carci noma (OSCC) developing from OED on ventral tongue. Both of our cases progressed from mild OED to moderate OED, and then severe OED, eventually resulting in OSCC. Our cases underscore that clinicians must look into pathological description of epithelial dysplasia, not only clinical diagnosis of the lesion. Clinical features such as indurated nodules, a mixed white and red appearance, and thick verrucous plaques were closely monitored, enabling the prompt detection of OSCC through biopsy of the relevant site.

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Treatment of Oral Lichen Planus with Intralesional Injection of Steroids: Case Reports

Sangwon YEO ; Juwon KIM ; Jeong-Seung KWON ; Younjung PARK ; Min CHANG ; Hyung-Joon AHN

Journal of Oral Medicine and Pain.2024;49(4):158-163. doi:10.14476/jomp.2024.49.4.158

Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology affecting the oral mucosa. As it is difficult to cure, long-term management aims to improve the patient’s quality of life by reducing inflammation and alleviating pain. While systemic and topical corticosteroids are commonly used treatments, their efficacy is often limited by side effects or poor compliance. This study investigates the effectiveness of intralesional steroid injections (ILIs) in patients resistant to conventional therapies. Two patients with refractory OLP were treated with intralesional triamcinolone acetonide injections administered directly into affected mucosal sites at minimal intervals. Clinical outcomes were assessed over an extended follow-up period using the Numerical Rating Scale (NRS) for pain and evaluations of lesion severity. Both patients exhibited significant and sustained improvements in pain and lesion severity following ILIs treatment. In one case, the NRS score decreased from 8 to 2 over multiple visits, with no additional injections needed in the last 6 months. In the other case, the NRS score improved from 6 to 1, requiring minimal injections for maintenance. The localized treatment was well-tolerated without significant side effects. ILIs are an effective and safe treatment for refractory OLP, offering durable symptom relief while minimizing systemic exposure and associated side effects.This approach provides a practical option for long-term management of OLP, enhancing patient quality of life when conventional therapies are inadequate. Future research should explore the potential of combining ILI with other immunomodulatory agents to further improve therapeutic outcomes.

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Changes in Salivary Parameters, Halitosis, Oral Health, and Systemic Disease with Increasing Age

Solsol SEO ; Tae-Seok KIM ; Yeon-Hee LEE

Journal of Oral Medicine and Pain.2024;49(4):124-134. doi:10.14476/jomp.2024.49.4.124

Purpose: The elderly population in South Korea is steadily increasing, ushering in the super-aging era and emphasizing the need for oral health management. This study aimed to investigate changes in salivary flow rate, salivary buffer capacity, halitosis, oral health, and systemic diseases with age. Methods: This study was conducted retrospectively from August 2020 to May 2023, including 274 patients (66 males, 208 females; mean age 59.39±16.10 years) presenting with xerostomia or halitosis. Results: For salivary parameters, no significant differences were observed in unstimulated salivary flow rate, stimulated salivary flow rate, salivary pH, or buffer capacity across age groups (all p>0.05), contrary to expectations. Regarding halitosis, methyl mercaptan levels were significantly associated with age (p=0.049), though patients in their 20s exhibited the highest levels. Volatile sulfur compound levels showed a strong correlation with subjective halitosis (r=0.621, p<0.001). In terms of oral health, increased age was significantly associated with tongue coating (r=0.205, p=0.001). Among systemic diseases, hypertension (p=0.001) and diabetes (p=0.010) showed significant differences across age groups. The drug that showed a statistically significant correlation with increasing age was amlodipine (r=0.249, p=0.001), a widely used antihypertensive agent. Amlodipine usage was significantly associated with oral hygiene issues, sticky saliva, calculus deposition, and tongue coating (all p<0.05). The results highlight the changes in salivary parameters and other oral and systemic factors with age, along with their interrelationships. Conclusions These findings provide valuable insights to aid clinicians in developing optimal treatment plans for xerostomia and halitosis and in effectively managing oral health in the elderly population.

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Trigeminal Neuralgia with Autonomic Symptoms: A Case Report

Juwon KIM ; Sangwon YEO ; Min CHANG ; Jeong-Seung KWON ; Hyung-Joon AHN ; Jong-Hoon CHOI ; Younjung PARK

Journal of Oral Medicine and Pain.2024;49(4):148-152. doi:10.14476/jomp.2024.49.4.148

Trigeminal neuralgia (TN), primarily affecting the maxillary nerve and mandibular nerve, manifests as sudden and severe facial pain without autonomic symptoms such as tearing and ptosis. However, rare cases present with such symptoms, which necessitate differentiation from short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), as these disorders share similar pain episodes within the trigeminal sensory territory, often including autonomic manifestations. This study aims to clarify distinguishing features and facilitate accurate diagnosis. We report a 63-year-old female presenting with left upper premolar area pain upon infraorbital, zygoma, and upper lip contact. Her pain history followed re-endodontic and prosthodontic treatment of the left upper second premolar, and examination showed electric-like sensations without spontaneous pain. Treatments included anti-inflammatory medications and occlusal adjustments, which proved ineffective. A tentative diagnosis of TN led to treatment with carbamazepine, oxcarbazepine, and baclofen, noting episodic conjunctival injection and asymmetric tongue sensations during severe attacks. This case, marked by touch-evoked, short-duration pain in the maxillary branch and late-emerging mild autonomic symptoms, responded well to carbamazepine, favoring a TN diagnosis over SUNCT/SUNA. The presence of autonomic symptoms in suspected TN cases necessitates careful reevaluation to distinguish from SUNCT/SUNA, particularly when carbamazepine response is suboptimal. Accurate differentiation is crucial for targeted therapy, as medication efficacy varies significantly between these conditions.

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The Effect of Stabilization Splint Use on Bite Force in Patients with Bruxism

Ji Rak KIM ; Jin Woo CHUNG

Journal of Oral Medicine and Pain.2024;49(4):102-108. doi:10.14476/jomp.2024.49.4.102

Purpose: This study aimed to assess changes in maximal bite force and left-right bite force differences after stabilization splint use in patients with bruxism. Methods: A total of 22 patients with bruxism (11 males, 11 females) participated in this study. Participants were instructed to use a mandibular stabilization splint nightly during sleep. Maximal bite force was measured using Dental Prescale II prior to stabilization splint use, then at one week, two weeks, and monthly intervals up to six months. Results: No significant changes in maximum bite force were observed over the 6-month period following stabilization splint use. A significant reduction in maximal bite force was observed between the baseline measurement and one week after stabilization splint use (p<0.001). A subsequent increase was observed between one and two weeks (p=0.002), while no significant changes were found in the later time points up to six months. Throughout the observation period, differences in maximal bite force between the left and right sides were also not significant. The left-right bite force difference also decreases temporarily but returned to baseline levels in subsequent measurements. No significant differences in bite force changes were observed based on age or sex. Conclusions The use of stabilization splint in patients with bruxism initially reduced maximal bite force, with forces gradually returning to baseline over time. Additionally, the temporary reduction in left-right bite force difference suggests an adaptive response to stabilization splint use.

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Obstructive Sleep Apnea: Pathophysiology and Treatment

Jee-Won JANG ; Hye-Min JU ; Hye-Mi JEON ; Yong-Woo AHN ; Sung-Hee JEONG ; Soo-Min OK

Journal of Oral Medicine and Pain.2024;49(4):71-78. doi:10.14476/jomp.2024.49.4.71

Obstructive sleep apnea (OSA) is a disorder driven by a combination of anatomical and functional factors. A narrow upper airway, fatty deposits around the tongue, and enlarged soft tissues all contribute to airway collapse. Additionally, reduced neuromuscular activity during sleep and increased instability in respiratory control heighten the risk of airway obstruction. OSA is linked to serious health problems, including metabolic disorders, cardiovascular diseases, and excessive daytime sleepiness, underscoring the importance of early diagnosis and treatment. Diagnosis is typically made through polysomnography, and continuous positive airway pressure therapy remains the most effective treatment.For individuals with mild to moderate OSA, oral appliance therapy offers a viable alternative, while emerging treatments such as hypoglossal nerve stimulation and pharmacological interventions provide additional options. By identifying distinct OSA phenotypes, personalized treatment approaches can be developed, and future research should focus on optimizing these strategies to meet the specific needs of individual patients.

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Transcriptional Response of a Porphyromonas gingivalis ppk-Deficient Mutant Exposed to Exogenous Polyphosphate

Cheul KIM

Journal of Oral Medicine and Pain.2024;49(4):91-101. doi:10.14476/jomp.2024.49.4.91

Purpose: Porphyromonas gingivalis is a key pathogen in periodontitis, involved in systemic diseases. P. gingivalis relies on various survival strategies, including the synthesis of intracellular polyphosphate (polyP), which is synthesized by polyphosphate kinase encoded by the ppk gene. In contrast, exogenous polyP inhibits the growth of various bacteria, including P. gingivalis. This study examines the transcriptional response of the ppk-deficient P. gingivalis mutant (CW120) to stress induced by exogenous polyP, focusing on gene expression changes compared to the parent strain, P. gingivalis 381. Methods: Both P. gingivalis CW120 and 381 strains were exposed to exogenous polyP, followed by microarray analysis. Differentially expressed genes (DEGs) with more than a 2-fold change were identified and further validated by quantitative reverse transcription-polymerase chain reaction. Results: Exposure to polyP led to significant transcriptional changes in CW120, with 583 DEGs identified. Notably, genes related to energy metabolism and cell division were downregulated, while ribosomal protein genes were upregulated. Lipopolysaccharide (LPS)-related genes exhibited altered expression in both strains, indicating that these changes are not directly linked to the ppk gene. Since different P. gingivalis LPS isoforms interact with Toll-like receptor 2 (TLR2) and TLR4 in distinct ways, polyP-induced changes in LPS could influence TLR-mediated immune responses, which are linked to inflammation and pain signaling. Conclusions The findings highlight the role of polyP in modulating P. gingivalis gene expression, particularly in the ppk-deficient mutant, affecting energy metabolism, cell division, and LPS production. The potential impact of polyP on TLR-mediated immune pathways suggests its role in modulating bacterial virulence and contributing to chronic pain conditions. Future studies should explore these interactions to inform therapeutic strategies targeting P. gingivalis-related diseases.

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