顎関節症の診療ガイドライン作成における"Patient Question"収集のための患者ボランティアに対する個別面接調査

With the aim of formulating clinical practice guidelines for the initial treatment of temporomandibular disorders (TMD), we carried out semi-structured interviews with volunteer patients who had suffered from TMD for the purpose of collecting patient question. The subjects (informants) were recruited through two newspapers. The guidelines committee chose 10 subjects from the 19 applicants through careful discussion. The interviews were conducted by trained interviewers in a special interview room, and the answers given by the informants were tape-recorded and transcribed into sentences. From these sentences, important words and phrases were extracted using a text mining method. When asked about their understanding of TMD, four informants answered "A disease with jaw displacement" and another four said "A disease that occurs when one's occlusion is not good." Only one informant had been correctly educated about TMD by the dentist. Three informants had received mouthpiece therapy but none knew the importance of and reasons for providing this therapy. Six informants were satisfied with the treatment they had received, but two were not. Usually, mouth-opening exercises, massages, and compresses were chosen as management therapy for problems of joint noise, restriction in mouth opening, or joint pain; this was followed by jaw rest, chiropractic treatment, and mouthpiece therapy. This investigation revealed that all informants had only a superficial knowledge about the pathological conditions and treatment methods for TMD. It is suggested that dentists should provide patients with adequate education regarding the symptoms and treatments of TMD.

顎関節症に対する初期治療ガイドライン作成における，Patient Question(PQ)収集を目的として，症状経験ボランティア患者への個別面接調査を実施した．対象者(以下インフォーマントと呼ぶ)を新聞紙上で募集した．19名の応募者の内10名(女性9名，男性1名)を委員会において検討したうえでインフォーマントと選定した．この10名に対する個別面接調査は，専用施設を用いて半構造化面接の手法に従って行った．質問に対する回答は録音したうえでテキスト化し，テキストマイニングの手法によってデータ化し集計した． 顎関節症への病識としては「あごがずれる病気」，「歯のかみ合わせが悪いと起こる病気」という回答がともに4例と最も多かった．しかしそのような疾患説明を受けた患者は1例のみであった．受けた治療はマウスピースが3例で最も多かったが，その治療の必要性，実施理由の説明を受けたインフォーマントはいなかった．治療に対する満足は6名が表明したが，不満との回答も2例みられた．PQの構成においては雑音，開口障害，疼痛に対して，提示した治療法では開口練習，マッサージ，湿布が最も多く，安静，整体，マウスピースが続いた． この面接調査により，インフォーマントがもつ病態や治療法に対する知識は全般的に少ないことが明らかになった．この原因として歯科担当医による病態や治療の説明がほとんどなされていないことが考えられた．

Journal of the Japanese Society for the Temporomandibular Joint


A 15-year clinical comparative study of the cumulative survival rate of cast metal core and resin core restorations luted with adhesive resin cement.

Cast metal cores were associated with a significantly lower CSR than resin cores, and significant risk factors for core failure were sex (male), absence of remaining coronal dentin, core restoration type (cast metal), and higher age at core insertion.

The International Journal of Prosthodontics


GRADEシステムによる顎関節症初期診療ガイドラインの作成

GRADEシステムによる顎関節症初期診療ガイドラインの作成

Journal of the Japanese Association for Dental Science


スプリント療法ガイドラインの確立

スプリント療法ガイドラインの確立


The relationship between temporomandibular joint pathosis and muscle tenderness in the orofacial and neck/shoulder region.

These results indicated painful disk displacement to possibly be correlated with ipsilateral muscle tenderness.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics


顎関節症のスプリント治療に関する実態調査 大学病院顎関節症外来および一般開業歯科医院における診療時間の比較


Characteristics of mandibular movements in patients with square mandible.

Despite a sufficient lateral excursion, motion of the mandible was limited by some factors at opening and suggests that the mode of lateral movements in SQM patients may differ slightly from those in healthy individuals.


家族の介護により経口摂取が可能となり，胃瘻から脱却した症例

家族の介護により経口摂取が可能となり，胃瘻から脱却した症例


舌接触補助床(PAP)のガイドライン(案)

舌接触補助床(PAP)のガイドライン(案)


Increased peripheral nerve excitability and local NaV1.8 mRNA up-regulation in painful neuropathy.

Cuff entrapment injury resulted in significantly elevated axonal excitability and increased NaV1.8 immunoreactivity in rat sciatic nerves. The concomitant axonal accumulation of NaV1.8 mRNA may play a role in the pathogenesis of this model of neuropathic pain.


Simvastatin induces the odontogenic differentiation of human dental pulp stem cells in vitro and in vivo.

Statin, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, is known to promote bone formation. However, it is not clear whether statin affects the differentiation of pulp cells. This study used a cell proliferation assay, cell cycle analysis, quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and in vivo transplantation to examine the effects of simvastatin on human dental pulp stem cells (DPSCs) in vitro and in vivo. Simvastatin at 1 mumol/L was able to significantly suppress the proliferation of DPSCs without inducing apoptosis. Quantitative RT-PCR revealed both osteocalcin and dentin sialophosphoprotein to be significantly up-regulated when DPSCs were cultured with simvastatin in comparison to bone morphogenetic protein-2 treatment. The in vivo transplantation data showed that simvastatin treatment promoted mineralized tissue formation. Taken together, these results suggest that statin might be an ideal active ingredient to accelerate the differentiation of DPSCs.


Botulinum toxin type a (150 kDa) decreases exaggerated neurotransmitter release from trigeminal ganglion neurons and relieves neuropathy behaviors induced by infraorbital nerve constriction.

Many patients with trigeminal neuropathies suffer severe chronic pain which is inadequately alleviated with centrally-acting drugs. These drugs also possess severe side effects making compliance difficult. One strategy is to develop new treatments without central side effects by targeting peripheral sensory neurons, since sensory neuron excitability and neurotransmitter release increase in chronic pain states. Such treatments may include the highly purified botulinum toxin type A 150 kDa (BoNT/A) which reportedly blocks vesicular neurotransmitter release. We set out to determine if experimental trigeminal neuropathy induced by infraorbital nerve constriction (IoNC) in rats could alter neurotransmitter release from somata of trigeminal sensory neurons and if it could be attenuated by BoNT/A. Thus, we monitored the secretory activity of acutely dissociated trigeminal ganglion (TRG) neurons from naïve and IoNC rats by measuring the fluorescence intensity of the membrane-uptake marker (N-(3-triethylammoniumpropyl)-4-(6-(4-(diethylamino)phenyl)hexatrienyl)pyridinium dibromide (FM4-64). FM4-64 staining showed that neurons possess a pool of recycled vesicles which could be released by high KCl (75 mM) application. BoNT/A pre-treatment of acutely dissociated TRG neurons from naïve rats significantly reduced the rate of FM4-64 dye release. Neurons isolated from TRG ipsilateral to IoNC exhibited significantly faster onset of FM4-64 release than neurons contralateral to IoNC (sham surgery). IoNC also produced long-lasting ipsilateral tactile allodynia, measured as large decreases of withdrawal thresholds to mechanical stimulation. Intradermal injection of BoNT/A in the area of infraorbital branch of the trigeminal nerve (IoN) innervation alleviated IoNC-induced mechanical allodynia and reduced the exaggerated FM4-64 release in TRG neurons from these rats. Our results suggest that BoNT/A decreases neuropathic pain behaviors by decreasing the exaggerated neurotransmitter release from TRG sensory neurons.


Diagnosis and Management for Temporomandibular Disorders under Consideration of the Etiology : Ordinal Management for Temporomandibular Disorders

顎機能障害の診断と発症原因を考慮に入れた治療 顎機能障害に対する一般的な治療法


岡山大学歯学部戦略的計画 求められている今後の対応策

岡山大学歯学部戦略的計画 求められている今後の対応策


Altered ATP release and metabolism in dorsal root ganglia of neuropathic rats.

These data suggest that peripheral nerve entrapment increases DRG metabolism and ATP release, which in turn is modulated by increased A1R activation.


高齢者の歯列欠損補綴治療法に関するチュートリアル学習とその効果

高齢者の歯列欠損補綴治療法に関するチュートリアル学習とその効果

The Journal of Japanese Dental Education Association

日本歯科医学教育学会雑誌


保存療法が有効ではなかった非復位性顎関節円板前方転位症例の臨床所見ならびにMRI所見の検討

Journal of the Japanese Society for the Temporomandibular Joint


Bidirectional alterations of hippocampal cannabinoid 1 receptors and their endogenous ligands in a rat model of alcohol withdrawal and dependence.

These data demonstrate that CIE treatment and withdrawal transiently down-regulates hippocampal CB1 Rs followed by a long-term up-regulation, including increased levels of endogenous cannabinoids. These findings are consistent with our hypothesis and suggest that long-term up-regulation of hippocampal CB1Rs may contribute to the long-term cognitive impairments in alcoholism. The data further suggest that the effectiveness of CB1R blockade in decreasing alcohol consumption may be greater after protracted abstinence from alcohol.

Alcoholism, Clinical and Experimental Research


Responses of the hypothalamic-pituitary-adrenal axis and pain threshold changes in the orofacial region upon cold pressor stimulation in normal volunteers.

This observed pain threshold increase might be due to the activation of an endogenous opioid system, such as increase in the circulating beta-endorphin levels.


Comparison of inter-twin concordance in symptoms of temporomandibular disorders: a preliminary investigation in an adolescent twin population.

There is controversy as to the genetic contribution to the pathogenesis of temporo-mandibular disorders (TMD). Several reports reveal a marked familial aggregation in the signs and symptoms of TMD, while others do not. Therefore, our goal was to investigate the hypothesis using a sophisticated research design, which was a well-known genetic survey inter-twin concordance assessment in the symptoms of TMD. This study is the first step to survey TMD symptoms of a twin group in junior and high schools as a preliminary trial. The 63 twins were asked to participate in this study in junior and senior high schools affiliated with the University of Tokyo, Japan, schools which kept ten twins in each grade for the purpose of several genetic survey programs. After excluding incomplete filling out of questionnaire sheets and data from male-female pairs, 43 monozygotic (MZ) (15.3+/-1.7 yrs, male/female = 17/26 pairs) and nine dyzygotic (DZ) (15.2+/-1.8 yrs, male/female = 6/3 pairs) twins were studied. Outcomes consisted of a prevalidated 14-item self-administered questionnaire, which assessed proband- and pair-wise concordance levels in the MZ and DZ twins. These results demonstrated that the MZ twins had a higher tendency of inter-twin concordance than DZ twins in terms of jaw pain in wide mouth opening (proband-wise concordance = 66.7% in MZ, 0% in DZ), difficulty in mouth opening (20% in MZ, 0% in DZ) and difficulty in mouth closing (50.0% in MZ, 33.3% in DZ), while there was no significant difference between the MZ and DZ concordance levels in other general health-related and behavior-related items, except toothache. However, the pair-wise concordance rates of jaw pain in wide mouth opening and difficulty in mouth opening in the MZ twins were not significantly higher compared to the DZ rate. Possibly, a genetic factor contributed to the pathogenesis of TMD in an adolescent population. The sample size needs to be increased, and there are plans to survey the next sample in the same schools.


Two types of neurotransmitter release patterns in isolectin B4-positive and negative trigeminal ganglion neurons.

Mammalian nociceptors have been classified into subclasses based on differential neurotrophin sensitivity and binding of the plant isolectin B4 (IB4). Most of the nerve growth factor-responsive IB4-negative (IB4 (-)) nociceptors contain neuropeptides such as substance P and calcitonin gene-related peptide, whereas the glial-derived neurotrophic factor-responsive IB4-positive (IB4 (+)) neurons predominantly lack such neuropeptides. We hypothesized that the differences in neuropeptide content between IB4 (+) and (-) neurons might be reflected in differences in stimulated exocytosis and/or endocytosis. To address this, we monitored the secretory activity of acutely dissociated neurons from adult rat trigeminal ganglia (TRG) using cell membrane capacitance (Cm) measurements and the fluorescent membrane-uptake marker N-(3-triethylammoniumpropyl)-4-(6-(4-(diethylamino)phenyl)hexatrienyl)pyridinium dibromide (FM4-64). Cm measurements were performed under whole-cell voltage clamp and neurons were depolarized from -75 mV to +10 mV to elicit exocytosis. Both types of TRG neurons showed similarly-sized, calcium-dependent increases in Cm, demonstrating that both IB4 (+) and (-) TRG neurons are capable of stimulated exocytosis. However, the peak Cm of IB4 (+) neurons decayed faster toward baseline than that of IB4 (-) neurons. Also, IB4 (+) neurons had stable Cm responses to repeated stimuli whereas IB4 (-) neurons loss their secretory response during repeated stimulation. These data suggested that the IB4 (+) neurons possess a faster rate of endocytosis and vesicle replenishment than IB4 (-) neurons. To test this, we measured vesicle trafficking with the fluorescent membrane dye FM4-64. FM4-64 staining showed that IB4 (-) neurons exhibit a larger pool of endocytosed vesicles than IB4 (+) neurons because the peak fluorescence increases in IB4 (-) neurons were larger but slower than in IB4 (+) neurons. However, the recycled vesicles were released faster in IB4 (+) compared with IB4 (-) neurons. Taken together these data suggest that the IB4 (+) TRG neurons have faster exocytosis and endocytosis than the IB4 (-) neurons.


Site-specific increases in peripheral cannabinoid receptors and their endogenous ligands in a model of neuropathic pain.

Selective activation of the peripheral cannabinoid receptor 1 (CB1R) has been shown to suppress neuropathic pain symptoms in rodents. However, relatively little is known about changes in CB1R and its endogenous ligands during development or maintenance of neuropathic pain. Using immunohistochemistry, Western blot, real-time reverse transcription polymerase chain reaction, as well as liquid chromatography/mass spectrometry, we studied the changes in CB1Rs and endocannabinoids N-arachidonoylethanolamine/anandamide (AEA) and 2-arachidonoylglycerol (2-AG) in rat lumbar (L4 and L5) dorsal root ganglia (DRG) after neuropathic pain induction (L5 spinal nerve ligation: SNL). Immunohistochemistry revealed that in control rats, CB1R is expressed in the majority (76-83%) of nociceptive neurons as indicated by co-labeling with isolectin B4 (IB4) or antibodies recognizing transient receptor potential vanilloid (TRPV1), calcitonin gene related peptide (CGRP), and the NR2C/2D subunits of the N-methyl-D-aspartate receptor. After L5 SNL, CB1R mRNA and protein increases in the ipsilateral uninjured L4 DRG whereas the percentages of CB1R immunoreactive (CB1R-ir) neurons remain unchanged in L4 and L5 DRG. However, for these CB1R-ir neurons, we observe significant increases in percentage of TRPV1-ir cells in ipsilateral L4 DRG, and decreases in percentage of IB4- and CGRP-co-labeled cells in ipsilateral L5 DRG. Levels of both AEA and 2-AG increase significantly only in the ipsilateral L5 DRG. These results are consistent with the preserved analgesic effects of cannabinoids in neuropathic pain and provide a rational framework for the development of peripherally acting endocannabinoid-based therapeutic interventions for neuropathic pain.


HSV-1-mediated NGF delivery delays nociceptive deficits in a genetic model of diabetic neuropathy.

A previous phase III clinical trial failed to show significant therapeutic benefit of repeated subcutaneous nerve growth factor (NGF) administration in the treatment of diabetic neuropathy. Animal studies have since shown that site-specific viral-mediated expression of NGF in the lumbar dorsal root ganglia prevents peripheral nerve dysfunction associated with chemically induced neuropathy. Using a Herpes simplex virus expression vector, we have investigated the effect of localized NGF expression in a genetic mouse model of progressive diabetic neuropathy, the +/+ Leprdb mouse. We found that site-specific delivery of NGF initially delayed the appearance of hypoalgesia, assessed by the Hargreaves test, by 1 month and effectively attenuated this deficit for 2 months over the approximately 10 months normal life-span of these animals. Once the disease progressed into its more severe stages, NGF, although still capable of altering the electrophysiological profile of the sensory A- and C-fibers and influencing the expression of p75 and substance P in the dorsal root ganglia, could no longer maintain normal nociception. These data suggest that maximal therapeutic benefit in future NGF-based gene therapy trials will be gained from early applications of such viral-mediated neurotrophin delivery.


岡山大学歯学部戦略的計画 教育に関する提案 岡山大学歯学部の理想的な将来のために


Characterization of patients with disc displacement without reduction unresponsive to nonsurgical treatment: a preliminary study.

Nonresponders can be characterized by their pretreatment pain-free mouth opening (<30 mm) in combination with MRI confirmation of "stuck" disc and unchanged disc shapes during mouth opening.

Journal of Oral and Maxillofacial Surgery


Neuronal differentiation of bone marrow-derived stromal stem cells involves suppression of discordant phenotypes through gene silencing.

Tissue engineering involves the construction of transplantable tissues in which bone marrow aspirates may serve as an accessible source of autogenous multipotential mesenchymal stem cells. Increasing reports indicate that the lineage restriction of adult mesenchymal stem cells may be less established than previously believed, and stem cell-based therapeutics await the establishment of an efficient protocol capable of achieving a prescribed phenotype differentiation. We have investigated how adult mouse bone marrow-derived stromal cells (BMSCs) are guided to neurogenic and osteogenic phenotypes. Naïve BMSCs were found surprisingly active in expression of a wide range of mRNAs and proteins, including those normally reported in terminally differentiated neuronal cells and osteoblasts. The naïve BMSCs were found to exhibit voltage-dependent membrane currents similar to the neuronally guided BMSCs, although with smaller amplitudes. Once BMSCs were exposed to the osteogenic culture condition, the neuronal characteristics quickly disappeared. Our data suggest that the loss of discordant phenotypes during BMSC differentiation cannot be explained by the selection and elimination of unfit cells from the whole BMSC population. The percent ratio of live to dead BMSCs examined did not change during the first 8-10 days in either neurogenic or osteogenic differentiation media, and cell detachment was estimated at <1%. However, during this period, bone-associated extracellular matrix genes were selectively down-regulated in neuronally guided BMSCs. These data indicate that the suppression of discordant phenotypes of differentiating adult stem cells is achieved, at least in part, by silencing of superfluous gene clusters.


Improvement of Chewing Ability by Complete Denture : A Case Report

全部床義歯による咀嚼障害の改善

Patient: A 58 year-old female patient visited the clinic with chief complaint of chewing difficulty with her complete dentures. These dentures did not have a sufficient size of denture base and the resin teeth were completely ground down. Treatment dentures were inserted and the form was transferred to final dentures.
Discussion: The risk of re-treatment and adjustment after the denture insertion was reduced by using the treatment dentures. The Cochrane Library reported that there is no difference between complete dentures and implant supported over dentures in terms of patient satisfaction/chewing ability, provided the patient has an adequate mandibular ridge.
Conclusion: Treatment dentures are important to reduce the risk of re-treatment.

The Journal of the Japan Prosthodontic Society


非歯原性歯痛の発症頻度およびその内容

非歯原性歯痛の発症頻度およびその内容

Journal of the Japanese Society for the Temporomandibular Joint


Self-reported remission, difficulty, and satisfaction with nonsurgical therapy used to treat anterior disc displacement without reduction.

These data suggest that palliative care would be more appropriate as the initial therapy to treat painful anterior disc displacement without reduction.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics


Clinical and MRI characteristics of patients unresponsive to conservative treatment for TMJ anterior disc displacement without reduction

保存療法が有効ではなかった非復位性顎関節円板前方転位症例の臨床所見ならびにMRI所見の検討


Gender differences in neuroselective current perception thresholds of the trigeminal and median nerves

Purpose : The goal of this study was to ascertain gender differences in sensory thresholds by measuring current perception threshold (CPT) values of the trigeminal and median nerves in healthy individuals.Materials and Methods : CPT values were measured using a Neurometer® (Neurotoron, Baltimore, MD, USA) when electrical stimulation of 2, 000, 250, or 5 Hz was applied to the left preauricular (trigeminal nerve) and thenar eminence (median nerve) regions in 20 healthy volunteers (10 males and 10 females with a mean age of 24.4 years). The day-to-day reliability of CPT was first verified in the trigeminal region by a test-retest method using an interclass correlation coefficient (ICC). The CPT values were then measured and statistically analyzed to evaluate whether the values were influenced by the electrical stimulation frequency and gender difference.Results : Irrespective of the stimulation frequency, the ICC values were high (2, 000 Hz : 0.62, 250 Hz : 0.80, 5 Hz : 0.86), showing the high day-to-day reliability of CPT. The electrical frequency of the stimulation significantly influenced the CPT (ANOVA : p<0.0001) ; the mean CPT value during 2, 000 Hz stimulation was significantly higher than the value during 250 and 5 Hz stimulation (Bonferroni test : p<0.001). For median nerve stimulation, the mean CPT was lower for women than for men, but no significant gender difference was identified (ANOVA : p=0.11). Conversely, gender exerted significant effects on CPTs (ANOVA : p=0.02) for trigeminal nerve simulation. As to stimulation frequency, the mean CPT following 2, 000 Hz stimulation of the trigeminal nerve was significantly lower for women than for men (Bonferroni test : p<0.001).Conclusion : The results suggest that healthy women are more sensitive to tactile or pressure sensations compared to healthy men, and that the effects of gender differences on the sensory threshold can be ignored with pain-related nerve fibers such as Aδ and C fibers.


Hyperosmolar solutions selectively block action potentials in rat myelinated sensory fibers: implications for diabetic neuropathy.

Diabetic neuropathy is a common complication of diabetes mellitus patients. It is a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves. Although plasma hyperosmolality is a common finding in diabetes mellitus, the effects of hyperosmolality on conduction of various sensory signal components have not been addressed in detail. Here we show that in rat dorsal root ganglion (DRG) preparations from normal rats, hyperosmolar solutions (360 mmol/kg, containing increased glucose, sucrose, NaCl, or mannitol) produce a selective block of signal propagation in myelinated sensory A-fibers. In compound action potential (CAP) recordings with suction electrodes, peak A-fiber CAP amplitude was selectively decreased (20%), while the C-fiber peak remained intact or was slightly increased. Hyperosmolar solutions had smaller effects on conduction velocity (CV) of both A- and C-fibers (approximately 5% decrease). Hyperosmolality-induced CAP changes could not be observed during recordings from isolated spinal nerves but were evident during recordings from desheathed spinal nerves. In intracellular recordings, hyperosmolar solutions produced a block of spinal nerve-evoked action potential invasion into the somata of some A-fiber neurons. Removal of extracellular calcium completely prevented the hyperosmolality-induced CAP decreases. Based on these data, we propose that the decreased CAP amplitudes recorded in human patients and in animal models of diabetes are in part due to the effects of hyperosmolality and would depend on the extracellular osmolality at the time of sensory testing. We also hypothesize that hyperosmolality may contribute to both the sensory abnormalities (paresthesias) and the chronic pain symptoms of diabetic neuropathy.


Relationship between capsaicin-evoked substance P release and neurokinin 1 receptor internalization in the rat spinal cord.

The relationship between substance P release and the activation of its receptor in the spinal cord remains unclear. Substance P release is usually measured by radioimmunoassay, whereas the internalization of the neurokinin 1 (NK1) receptor has been used to assess its activation by noxious stimuli. Our objective was to compare substance P release and NK1 receptor internalization produced by capsaicin in rat spinal cord slices. Superfusion of the slices with capsaicin for 3 min produced a gradual increase in substance P release that peaked 3-7 min afterward, and then decreased to baseline levels. The concentration-response curve for capsaicin was biphasic, with concentrations above 10 microM producing significantly less release. The effective concentration for 50% of response (EC(50)) for capsaicin, calculated from its stimulatory phase, was 2.3 microM. However, the potency of capsaicin to elicit NK1 receptor internalization in the same slices was one order of magnitude higher (EC(50)=0.37 microM) in lamina I, probably because NK1 receptors become saturated at relatively low concentrations of substance P. The potency of capsaicin to produce internalization was progressively lower in lamina III (EC(50)=1.9 microM) and lamina IV (EC(50)=14.5 microM), suggesting that neurokinins released in laminae I-II become diluted as they diffuse to the inner dorsal horn. To study the correlation between these two measures, we plotted substance P release against NK1 receptor internalization and fitted a saturation binding function to the points. The correlation was good for laminae I (R(2)=0.82) and III (R(2)=0.78), but it was poor (R(2)=0.35) for lamina IV because NK1 receptor internalization kept on increasing at high concentrations of capsaicin, whereas substance P release decreased. In conclusion, amounts of substance P able to activate NK1 receptors may fall under the threshold of detection of radioimmunoassay. Conversely, radioimmunoassay often detects levels of substance P release well over those required to saturate NK1 receptors in the superficial dorsal horn, but that may be able to activate these receptors in nearby regions of the spinal cord.


Recent evidence demonstrates that neurons in sensory ganglia contribute to sensory signaling in both physiological and pathological states. In vivo sampling from this site may provide important insights into which substances mediate or modulate sensory transmission. To address this possibility, we have applied the microdialysis technique to the guinea pig trigeminal ganglia (TG). The large size and easy access of the TG in the guinea pig make it an ideal sampling site, while the somatotopic organization allows for specific regions of innervation to be studied at the ganglionic level. This report describes the use of microdialysis probes within the TG and use recovery and analysis of substance P (SP) and adenosine triphosphate (ATP) as case in points. Various physiological and pharmacological manipulations can be made, for example release of peptides from ganglionic neurons can be monitored in the presence or absence of inflammation in the orofacial region. Microdialysis performed in the TG thus provides a valuable site for recovery and measurement of a variety of extracellular substances that may be integral in the processing of trigeminal sensory information.

Brain Research. Brain Research Protocols


Pressure-pain threshold determination in the oral mucosa: validity and reliability.

Fundamental knowledge of pain in the oral mucosa is lacking. We determined the validity and reliability of the pressure-pain threshold (PPT) measurement in the oral mucosa using a newly developed hand-held pressure algometer. Ten dentulous subjects were recruited, and the PPT was measured at the bilateral buccal (on the attached gingiva apical to the midline of the upper first premolars, 3 mm from the mucogingival junction) and the palatal sites (mid-point between the bilateral upper first molars). The PPT linearly increased with an increase in load-rate (P < 0.0001). The PPT yielded a high intra-individual stability both for the same-day consecutive trials and weekly sessions. The palatal site revealed a 4- to 4.65-fold greater PPT than the buccal sites (Bonferroni, P < 0.0001), whereas no difference was found between the bilateral buccal sites (P=0.663). Despite a great interindividual variation in the PPT, significant intra-individual correlations were found among the measurement sites. This suggested differences in individual sensitivity to pain in the oral mucosa, which may determine overall pain sensation specific to an individual. A pressure algometer described herein reliably assessed the PPT in the oral mucosa and sensitively discriminated PPT differences at different sites and at different load-rates, suggesting the reliability and validity of PPT measurements in the oral mucosa for clinical and research investigations.


Concurrent release of ATP and substance P within guinea pig trigeminal ganglia in vivo.

Neurons within sensory ganglia have been proposed to communicate via non-synaptic release of a diffusible chemical messenger, but the identity of the chemical mediator(s) remains unknown [J. Neurosci. 16 (1996) 4733-4741]. The present study addressed the possibility of co-released ATP and substance P (SP) within sensory ganglia to further advance the hypothesis of non-synaptic communication between sensory neurons. Microdialysis probes inserted into trigeminal ganglia (TRGs) of anesthetized guinea pigs were perfused with artificial cerebrospinal fluid and the collected perfusate analyzed for ATP and SP content using the firefly luciferin-luciferase (L/L) assay and radioimmunoassay, respectively. Significant reversible increases in ATP and SP levels were observed after infusion of 100 mM KCl or 1 mM capsaicin. Ca(2+)-free ACSF produced an eightfold increase in ATP levels, interpreted as a decrease in activity of Ca(2+)-dependent ecto-nucleotidases that degrade ATP. In contrast, KCl-induced release of ATP in the presence of normal Ca(2+) was blocked by Cd(2+), a voltage-gated Ca(2+) channel blocker, illustrating Ca(2+)-dependence of evoked ATP release. Since ganglionic release of ATP could arise from several neuronal and non-neuronal sources we directly tested acutely dissociated TRG neuron somata for ATP release. Neuron-enriched dissociated TRG cells were plated onto glass tubes and tested for ATP release using the L/L assay. Robust ATP release was evoked with 5 microM capsaicin. These data suggest that ATP is released concurrently with SP from the somata of neurons within sensory ganglia.


Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction.

The common methods for treating anterior disk displacement without reduction (ADDwor) are not based on randomized controlled clinical trials. Our study evaluated non-surgical treatments in 69 MRI-confirmed ADDwor subjects (m/f = 6/63). Subjects were randomly assigned to a control group and one of two treatment groups. Outcomes included maximum mouth opening, visual analogue scale of pain, and daily activity limitation. Calibrated examiners collected data at the initial interview and at 0, 2, 4, and 8 weeks of treatment. At the eight-week point, within-group improvements were present for all variables, for all groups. Between-group differences were not highly evident, with only mean daily activity limitation for the self-care/NSAID group being significantly lower than that of the occlusal appliance/jaw mobilization + self-care/NSAID group at the two- and four-week time-points. These results suggest that ADDwor subjects will improve with only minimal treatment intervention, and no significant difference was evident for the treatments tested and the control condition.


Rehabilitation of biting abilities in patients with different types of dental prostheses.

This study investigated the masticatory rehabilitation of subjects wearing different types of prostheses. Biting abilities per person (biting force, biting pressure and occlusal contact area) were assessed with a pressure detecting sheet (Prescale(R)). Five hundred and ninety volunteers were divided into four groups according to the type of posterior dentition: complete denture, removable partial denture, fixed partial denture, and full natural dentition groups. The biting forces of the fixed partial, removable partial and complete denture wearers were 80, 35 and 11% respectively, when expressed as a percentage of the subjects with a natural dentition. The complete denture wearers showed the highest biting pressure among the four groups, followed by the removable partial denture wearers. In a clinical intra-individual study, the biting abilities of 85 subjects, without (before insertion of) and with (after insertion of) renewed prostheses, were compared. No significant differences were found between biting before and immediately after insertion of the prostheses. However, the biting force and occlusal contact area increased 2 months after insertion of the prostheses. This study confirmed past clinical studies indicating an impaired masticatory function of denture wearers. The functional adaptation to new prostheses had improved at evaluation 2 months after insertion.


Inflammation-induced changes in primary afferent-evoked release of substance P within trigeminal ganglia in vivo.

Substance P (SP) is synthesized in a subset of nociceptive sensory neurons and is released from their peripheral and central terminals. Here we demonstrate with the use of in vivo microdialysis and radioimmunoassay techniques that SP is also released within trigeminal ganglia following intraganglionic application of KCl, veratridine or capsaicin, and after electrical stimulation of peripheral afferent fibers. Both the basal and KCl-evoked release of SP are shown to be dependent on extracellular calcium. Using the turpentine-induced model of unilateral orofacial inflammation we also show that both the basal and KCl-evoked release of SP within trigeminal ganglia are greatly increased on the inflamed side 48 h after induction of inflammation. Coupled with previous demonstrations of excitatory effects of SP on sensory neurons, these results suggest that SP fulfils the role of a non-synaptically released diffusible chemical messenger that may modulate the somatic excitability of neurons within sensory ganglia in inflammatory pain states.


Trigeminal neuralgia due to an acoustic neuroma in the cerebellopontine angle.

This case report first reviews the intracranial tumors associated with symptoms of trigeminal neuralgia (TN). Among patients with TN-like symptoms, 6 to 16% are variously reported to have intracranial tumors. The most common cerebellopontine angle (CPA) tumor to cause TN-like symptoms is a benign tumor called an acoustic neuroma. The reported clinical symptoms of the acoustic neuroma are hearing deficits (60 to 97%), tinnitus (50 to 66%), vestibular disturbances (46 to 59%), numbness or tingling in the face (33%), headache (19 to 29%), dizziness (23%), facial paresis (17%), and trigeminal nerve disturbances (hypesthesia, paresthesia, and neuralgia) (12 to 45%). Magnetic resonance imaging with gadolinium enhancement or computed tomography with contrast media are each reported to have excellent abilities to detect intracranial tumors (92 to 93%). This article then reports a rare case of a young female patient who was mistakenly diagnosed and treated for a temporomandibular disorder but was subsequently found to have an acoustic neuroma located in the CPA.


Four-year longitudinal course of TMD symptoms in an adult population and the estimation of risk factors in relation to symptoms.

The possible etiologic significance of these factors in TMD should be validated by future research.


Comparison of biting forces in different age and sex groups: a study of biting efficiency with mobile and non-mobile teeth.

This study aimed (1) to investigate the influences of sex, age and number of teeth on biting ability through a descriptive survey, and (2) to compare the biting ability between the subjects with and without mobile teeth in a case-control study. A total of 687 subjects cooperated in the descriptive survey. Each subject bit on a pressure detecting sheet with their maximum biting force. Three indices of biting ability: biting pressure (MPa), biting force (N) and occlusal contact area (mm2) were calculated from the impressed marks on the sheet using a high vision video processor system. These indices were correlated well with the number of teeth according to the multiple regression analysis. In the case-control study, matching procedures with sex, age and number of teeth were performed between the subjects with and without mobile teeth. No differences in the three indices were observed between the two well-balanced groups. The results showed that the number of teeth is most important to maintain biting ability, and that the presence of mobile teeth does not always reduce biting ability.


Clinical predictability of temporomandibular joint disc displacement.

Single items from a typical clinical examination have proved disappointing in their predictive value for temporomandibular joint (TMJ) disc displacement. Only one criterion (the 12 o'clock) is used to diagnose normal disc position. According to this criterion, the posterior band of the disc should be located at the top of the condyle, at the 12 o'clock position. The purpose of this study was to determine which signs and symptoms provide a valid prediction of the condition of the joint based on 4 magnetic resonance imaging (MRI) criteria used to define normal disc position. Sagittal MRI and clinical findings of 137 temporomandibular disorder patients and 23 normal asymptomatic volunteers were used. Three calibrated and blinded observers interpreted the images. Disc position with the mouth closed was evaluated based on 4 MRI criteria: 12, 11, 10 o'clock, and the intermediate zone. Disc position with the mouth open was determined based on one criterion. It was considered normal if the intermediate zone of the disc was located between the condyle and the articular eminence. Joints were classified as normal or as having disc displacement with or without reduction. The sensitivity and specificity of multiple clinical parameters for predicting the condition of the joint established by each of these 4 gold-standard MRI criteria were then determined. Regarding disc displacement with reduction, significant differences were observed in the sensitivity and specificity of all of the clinical parameters used to predict the imaging diagnosis established by each of the criteria. Concerning disc displacement without reduction, no significant differences were observed. The intermediate zone criterion was the criterion that most accurately reflected the condition of the joint. The clinical predictability of the disorder diagnosed according to this criterion suggests that clinical findings alone are too often nonspecific as predictors of the imaging stage of disc displacement. However, we found that combining the most sensitive clinical items to predict the disorder and using an overall criterion for positivity to interpret the results led to an impressive increase in the specificity of the combination, enabling false-positive diagnoses to be excluded.


口腔顔面慢性疼痛に対する塩酸アミトリプチリンの鎮痛効果ならびに副作用

口腔顔面慢性疼痛に対する塩酸アミトリプチリンの鎮痛効果ならびに副作用

The Journal of the Japan Prosthodontic Society


顎関節症類似の症状を呈した間代性神経障害性疼痛 血中カルバマゼピン濃度測定

顎関節症類似の症状を呈した間代性神経障害性疼痛 血中カルバマゼピン濃度測定


歯科治療に関連して発症した持続性神経障害性疼痛 非定型性歯痛

歯科治療に関連して発症した持続性神経障害性疼痛 非定型性歯痛


いびきに関する文献的考察

いびきに関する文献的考察

The Journal of the Japan Association of Cranio-Mandibular Orthopedics


Diagnostic value of 4 criteria to interpret temporomandibular joint normal disk position on magnetic resonance images.

These results suggest that the intermediate zone criterion for disk displacement is the more stringent criterion and the one that would yield the lowest number of false positives when the disk position is being judged in the closed-mouth sagittal view.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics


Macroscopic osseous changes in the temporomandibular joint related to dental attrition in Japanese macaque skull.

The purpose of this study was to investigate the relationship between osseous changes in the temporomandibular joint (TMJ) and dental attrition in the Japanese macaque. One hundred and thirty Japanese macaque skulls (54 male and 76 female) from animals which had been bred in the same environment, were randomly sampled from a collection at the Primate Research Institute of Kyoto University. The age at death had been recorded in all cases. TMJ osseous changes were independently evaluated by three examiners, and were defined as an irregular surface or a perforated compact bone layer with a markedly irregular surface on either the temporal or condylar components. Age was a significant factor in predicting TMJ osseous changes (P < 0.001). A strong relation was observed between age and dental attrition (P < 0.001), while dental attrition was not a significant factor in predicting TMJ osseous changes (P = 0.334). The prevalence TMJ osseous changes in male animals was slightly higher than in females (P = 0.057). The results of this study suggest that osseous changes in the macaque TMJ are mainly related to age, not to dental attrition.


The validity of clinical examination for diagnosing anterior disk displacement with reduction.

Our results suggest that anterior disk displacement with reduction can be diagnosed with considerable accuracy through the use of a clinical examination only.


The validity of clinical examination for diagnosing anterior disk displacement without reduction.

Our results suggest that the predictability of historical or clinical findings to differentiate anterior disk displacement without reduction from other diagnoses is not high.


The relationship between signs and symptoms of temporomandibular disorders and bilateral occlusal contact patterns during lateral excursions.

The relationship between signs and symptoms of temporomandibular disorders (TMD) and bilateral occlusal contact patterns was investigated in 143 TMD patients (mean age: 34.0 +/- 15.9 years; 38 male and 105 female). In addition to an interview regarding chief complaints and accompanying symptoms, various muscles and the temporomandibular joints were palpated bilaterally and occlusal analyses were made. Only 5 out of 108 paired variables were found to be significantly associated by using the chi-squared test. Medial pterygoid muscle pain on palpation showed significant associations with the occlusal contact pattern (P < 0.005), especially working side contacts (interocclusal tooth contacts on the working side) (P < 0.005), during contralateral excursions; sternocleidomastoid muscle pain on palpation showed a significant association with balancing side contacts (interocclusal tooth contacts on the balancing side) during ipsilateral excursions P < 0.05); shoulder stiffness and pain in the eye showed significant associations with balancing side contacts during contralateral excursions (P < 0.05). The results show only a weak relationship between some TMD symptomatology and bilateral occlusal contact patterns during lateral excursions. The findings suggesting the specific laterality of a few TMD signs and symptoms associated with particular occlusal contacts may deserve closer case-control study.


Effects of a bite-raising splint on the duration of the chewing cycle and the EMG activities of masticatory muscles during chewing in freely moving rabbits.

Metal bite-raising splints of 0.5 mm thickness were attached to the upper molar teeth on both sides of the jaw in rabbits. The effects of these splints on masticatory behaviour during the chewing of soft food (bread) by freely moving rabbits were investigated. We recorded electromyograms (EMGs) of the masseter and digastric muscles. The animals exhibited prolongation of the chewing cycle, decreased EMG activity of the masseter muscle and increased EMG activity of the digastric muscle during chewing after introduction of the bite-raising splints. The effects of the splints on the activities of masticatory muscles were abolished by bilateral sectioning of the maxillary and inferior alveolar nerves. It seems likely that afferents from oral sensory receptors were responsible for the changes in masticatory behaviour after the introduction of the occlusal splint.


The long-term effect of occlusal therapy on self-administered treatment outcomes of TMD.

Because of a lack of substantial scientific data, the efficacy of occlusal therapy for the management of temporomandibular disorders (TMD) is still controversial. Of a total of 1405 consecutive TMD patients examined over the last 10 years, 369 (26.3%) were determined to have completed treatment at least 1 year before the present survey. A sample questionnaire was mailed to each patient in this sample population. The questionnaire failed to reach 46 patients; of the 323 patients who received the questionnaire, 260 (80.5%) responded. The mean duration of time between their last visit and this survey was 3.7 years. The questionnaire elicited information on treatment outcomes, present treatment needs, and current signs and symptoms. Participants were divided into two treatment groups: (a) those who underwent some occlusal therapies (Phase II) following successful reversible therapies (Phase I) (20 men and 114 women); and (b) those who underwent reversible therapy only (33 men and 93 women). Participants were further differentially diagnosed into five diagnostic subgroups of TMD, based on the clinical examination at the initial visit, tomography, and, for some patients, magnetic resonance imaging. The subgroups included myalgia, arthralgia, anterior disc displacement with an without reduction, and osteoarthritis/osteoarthrosis. Only 12.3% of the total population surveyed reported lack of improvement to an acceptable level and further need for treatment. The remaining patients reported satisfactory results in the reduction of TMD symptomatology and no further need for treatment, because their symptoms had either disappeared or improved to an acceptable level. Regardless of treatment groups and diagnostic subgroups, the current subjective signs and symptoms were negligible in most patients, and mean mouth openings were in the normal range. No particular diagnostic subgroups seemed to have significantly better outcome following Phase II occlusal therapy. These results suggest that the majority of TMD signs and symptoms improve to an acceptable level with only reversible therapy, and the long-term value of additional occlusal therapy following reversible therapy is minimal. Therefore, permanent occlusion-changing therapies apparently are not generally needed to maintain TMD symptom reduction over time.


The influence of observer calibration in temporomandibular joint magnetic resonance imaging diagnosis.

These data suggest that after calibration trials, it is possible for three examiners to obtain reliable and reproducible results in reporting temporomandibular joint disk position on magnetic resonance images.


質問表を用いた顎関節症の咬合治療に関する遠隔予後調査(第1報) 顎関節症患者全体における咬合治療の有効性

The Journal of the Japan Prosthodontic Society


Long-term follow-up study on drop-out TMD patients with self-administered questionnaires.

Although patient attrition might be a serious threat to the validity of treatment-outcome studies on temporomandibular disorders (TMD), studies on TMD patient attrition are scarce. Of the 1405 consecutive TMD patients examined in a recent 10-year period, 367 (26.1%) drop-out patients or patients identified with a control group were sampled. A mailed questionnaire failed to reach 41 patients, and 203 (62.3%) were returned. The questionnaire elicited information on reasons for dropping out, changes in symptoms, treatment received in other clinics after dropping out, present treatment needs, and current signs and symptoms. Dropouts were divided into two groups: (1) those who failed to show up for their first scheduled appointment after the clinical examination; (2) those who failed to complete treatment. A group of patients who were judged by the examiner not to need treatment were included as a control group. The main reasons for dropping out were environmental obstacles, perceived improvement of the disease, and dissatisfaction with services. Only 21.7% considered themselves to be in need of treatment, and only 10.3% had visited other clinics after dropping out. Only 8.9% complained of the continued aggravation of symptoms, whereas 57.6% reported improvement. In addition, pain, dysfunction, and daily activity limitation tended to improve with time, although temporomandibular joint noise tended to persist. These results suggest that TMD signs and symptoms tend to decrease in patients after dropping out, and that the natural fluctuation of TMD signs and symptoms should be taken into consideration when treating TMD.


Temporomandibular disorders in the adult population of Okayama City, Japan.

In order to discover the prevalence of signs and symptoms of temporomandibular disorders (TMD) in Japan, and the difference in the prevalence among various sex and age groups in the Japanese population, 672 individuals (304 males and 368 females, age range 20-92 years) were selected randomly in Okayama City, Japan, and were investigated by means of questionnaires and clinical examinations. The reported frequency of symptoms was: TMJ sounds 24%, facial-TMJ-jaw pain 11%, headache 27%, teeth clenching 30%, and grinding 34%. The percent frequency of the following signs was: impaired mouth opening 5%, clicking 46%, reciprocal clicking 20%, crepitus 19%, TMJ tenderness 6%, and masticatory muscle tenderness 21%. The subjects with TMJ clicking were more frequently females than males. TMD signs and symptoms were found to be common in all age groups, but they were fewer in the older than in the younger age group. The younger-aged subjects with clicking appeared with significant frequency, whereas crepitus was populated with significant frequency by the oldest age group.


顎関節症の病型分類による疫学的研究 有症群の解析

顎関節症の病型分類による疫学的研究 有症群の解析

Journal of the Japanese Society for the Temporomandibular Joint


オクルーザルボンディング法に関する実験的研究 ポーセレンアンレーの厚みと支台歯形態が圧縮強度に及ぼす影響

The Journal of the Japan Association of Cranio-Mandibular Orthopedics


ヒト関節円板の形態学的特徴と関節円板転位の関連に関する肉眼解剖学的研究

ヒト関節円板の形態学的特徴と関節円板転位の関連に関する肉眼解剖学的研究


各種頭蓋顎関節エックス線規格撮影装置により得られた顎関節像の比較

各種頭蓋顎関節エックス線規格撮影装置により得られた顎関節像の比較


診療ガイドラインの作成と変遷

診療ガイドラインの作成と変遷


歯科用金属による金属アレルギーの臨床病態と補綴学的対応に関する多施設調査

歯科用金属による金属アレルギーの臨床病態と補綴学的対応に関する多施設調査

Journal of the Japanese Association for Dental Science


高齢者の栄養障害に義歯装着がもたらす効果と高齢義歯装着者への摂食・栄養指導のガイドラインに関するプロジェクト研究


Peripheral administration of botulinum toxin type A neurotoxin reverses trigeminal neuropathic pain symptoms


Peripheral administration of botulinum toxin type A decreases exaggerated neurotransmitter release and reverses neuropathy-induced gene expression changes in trigeminal ganglia


三叉神経痛において生じている神経節細胞過敏化のメカニズムの解明と治療法開発

三叉神経痛において生じている神経節細胞過敏化のメカニズムの解明と治療法開発


ニホンザル顎関節の形態計測学的研究

ニホンザル顎関節の形態計測学的研究

京都大学霊長類研究所年報

京都大学霊長類研究所年報