ArticleLiterature Review

Prevalence of psychosocial impairment in Temporomandibular Disorder patients: a systematic review

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Abstract

Background Several studies have described high levels of psychosocial disorders in patients with temporomandibular disorders (TMD), but an estimate of their prevalence in populations of TMD patients has never been assessed systematically Objective To conduct a systematic review of the literature on the prevalence of Research Diagnostic Criteria for TMD (RDC/TMD) axis II findings in TMD patients Methods Search for articles was carried out by two independent researchers to retrieve papers published after 1992. Inclusion was reserved to observational studies with a minimum sample size of 100 individuals, which used RDC/TMD diagnostic protocol. Quality assessment was performed with the adoption of the Methodological evaluation of Observational Research (MORE) Results 1,186 citations were obtained from search strategy, but only 14 filled the inclusion criteria. Included papers reported somatization, depression and/or pain‐related disability prevalence or scores from populations of 12 different countries. A broad range in the prevalence of moderate to severe somatization in patients with TMD was observed, ranging from 28.5% to 76.6%. Similar results were found for depression, with moderate to severe levels in 21.4% to 60.1% of patients. Finally, most patients were rated as grade I or II of the Graded Chronic Pain Scale, whereas high pain‐related impairment was present in 2.6% to 24% of the individuals Conclusion The prevalence of severe to moderate somatization and depression were high in TMD patients, while severe physical impairment was not commonly reported. This article is protected by copyright. All rights reserved.

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... The etiology of TMD is multifactorial and psychological factors can also contribute to the etiological causes (4). Several studies have described a high prevalence of psychosocial disorders in patients with TMD (5). TMD may affect health-related quality of life (HRQOL). ...
... Several studies have shown that a high prevalence of depression in TMD patients (21.4%-60.1%) and depression is considered an important risk factor for TMD (4,5). Similarly, patients with depression, present with high prevalence of TMD. ...
... Treatment of TMD can reduce depressive behavior and improve QoL. The findings of this study are similar to those of studies conducted in the general population indicating an increased frequency of depression among patients with TMD (4)(5)(6). In this study, the MCSS and PCSS were lower in patients with mTMD. ...
... TMD is considered as one of the main triggers in inducing orofacial pain of nondental origin, which can have a negative impact on a patient's functionality and psychological status [1,2], which ultimately can affect quality of life (QoL) [3]. Hence, the International Association for the Study of Pain (IASP) has defined TMD as a set of clinical conditions with signs and symptoms in the masticatory muscles, temporomandibular joint (TMJ) and associated structures (fatigue or stiffness of the jaws) and pain on palpation of the masticatory muscles [4]. ...
... Five out of 44 studies included patients within the cohort of less than 18 years old and above 70 years old [1][2][3]11,14], one study included patients between 13 and 63 years old [1] and the other ranged between 15 and 55 years [14], whereas three studies included patients in an age range of 16 to 70 years old [2,3,11]. Twelve studies were conducted on patients with a mean age in the range of 25 to 35 years [13,17,29,30,32,[34][35][36][37]39,42,44]. ...
... Five out of 44 studies included patients within the cohort of less than 18 years old and above 70 years old [1][2][3]11,14], one study included patients between 13 and 63 years old [1] and the other ranged between 15 and 55 years [14], whereas three studies included patients in an age range of 16 to 70 years old [2,3,11]. Twelve studies were conducted on patients with a mean age in the range of 25 to 35 years [13,17,29,30,32,[34][35][36][37]39,42,44]. ...
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This systematic review and meta-analysis (PROSPERO registration; ref CRD 42020198921) aimed to govern photobiomodulation therapy (PBMT) efficacy in temporomandibular disorder (TMD). PRISMA guidelines and Cochrane Collaboration recommendations were followed. Differences in pain reduction assessment by qualitative measurement with visual analogue scale pain (VAS), pressure threshold (PPT) and maximum mouth opening (MMO) were calculated with 95% confidence intervals and pooled in a random effects model with a subgroup analysis, evaluating the role of follow-up duration. Heterogeneity was analysed using Q and I2 tests. Publication bias was assessed by visual examination of funnel plot symmetry. Qualitative analysis revealed 46% of the 44 included studies showed a high risk of bias. Meta-analysis on 32 out of 44 studies revealed statistically significant intergroup differences (SSID) for VAS (SMD = −0.55; 95% CI = −0.82 to −0.27; Z = 3.90 (p < 0.001)), PPT (SMD = −0.45; 95% CI = −0.89 to 0.00; Z = 1.97 (p = 0.05)) and MMO (SMD = −0.45; 95% CI = −0.89 to 0.00; Z = 1.97 (p = 0.05)), favouring PBMT compared to control treatment strategies. Sensitivity analysis revealed SSID (SMD = −0.53; 95% CI = −0.73 to −0.32; Z = 5.02 (p < 0.0001)) with low heterogeneity (Τ2 = 0.02; χ2 = 16.03 (p = 0.31); I2 = 13%). Hence, this review, for first time, proposed suggested recommendations for PBMT protocols and methodology for future extensive TMD research.
... It is usually associated with psychological factors, muscle hyperactivity, injuries, among other factors (Avrella et al., 2015). Several authors (De La Torre Canales et al., 2018;Dworkin et al., 1990;Maia et al., 2021;List & Jensen, 2017;Oral, Bal Küçük, Ebeoğlu, & Dincer, 2009;Slade et al., 2007;Sójka, Stelcer, Roy, Mojs, & Pryliński, 2018) have indicated that physiological and psychological variables can interact in the TMD etiology, but due to the disagreement in understanding this relation, further studies are required to delimit this interaction. Gameiro, da Silva Andrade, Nouer and de ArrudaVeiga (2006) argue that there is a need to consider psychological factors such as stress, depression and anxiety as causative agents of TMD. ...
... TMD has been understood as a condition produced by multiple psychological or physical factors (De La Torre Canales et al., 2018;Dworkin et al., 1990;Maia et al., 2021;List & Jensen, 2017;Oral et al., 2009;Slade et al., 2007). Based on the present analysis, it was possible to identify the use of psychological concepts as outcome measures for dental interventions in cases of TMD. ...
Article
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As disfunções temporomandibulares (DTM) são condições biológicas que envolvem sinais e sintomas como dores crônicas na articulação temporomandibular e nos músculos da mastigação. O presente estudo tem como objetivo identificar quais e como conceitos psicológicos são descritos em artigos de intervenções odontológicas relacionadas à DTM, em artigos de revisão sistemática. Para isto foram utilizadas três bases de dados na busca e seleção: PubMed, Scopus e Web of Science. Aplicou-se em todas estas bases de dados a mesma formulação de termos-chave. Foram selecionados os artigos de revisões, publicados entre 2000 e 2017, escritos em inglês. Dos 4.092 artigos encontrados, sete foram selecionados descrevendo intervenções psicológicas envolvidas com o tratamento da DTM. Todos os artigos selecionados foram analisados com base em seus objetivos e discussões, considerando as características de apresentação e compreensão das variáveis psicológicas relacionadas à disfunção temporomandibular e às intervenções utilizadas. Para tanto, foram realizadas análises qualitativas e quantitativas. Pode-se concluir que a compreensão e a definição das variáveis psicológicas relacionadas à DTM não são evidentes, o que dificulta a produção de resultados claros sobre a eficácia dos diagnósticos e intervenções para DTM.
... Many studies have described high levels of psychosocial disorders in patients with TMD [2,5,[25][26][27][28][29], and in the present study, we found a high prevalence of depression and unspecified physical symptoms, including pain and anxiety, confirming a relationship between TMD and psychosocial disorders. This study indicates that some sociodemographic factors, health-related factors, and oral conditions are associated with TMD. ...
... Temporomandibular joint related pain recorded a 0.7% increase to 1.6% of complaints during the pandemic period compared to pre-pandemic period as a result of increased stress and anxiety arising from the uncertainties associated with the pandemic [18]. In addition, psychological disturbances are identified risk factors for the development of temporomandibular disorders [19]. Overall, pain related conditions were commonly observed during the pandemic probably due to their emergency nature. ...
... Moreover, people who are quarantined often feel lonely and angry because of losing their social communication (15). High stress and anxiety levels have been observed in healthcare personnel, mostly women (16,17). ...
Article
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Objective The purpose of the present study was to investigate the association of COVID-19 vaccination with the quality and quantity of sleep, the level of stress, and temporomandibular joint (TMJ) disorders (TMDs) in Iranian dental students.Materials and methodsIn this cross-sectional research, we applied a questionnaire including 30 questions on the Perceived Stress Scale (PSS), sleep quality and quantity, Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and vaccination status. All vaccinated students of the dental schools located in the city of Tehran were invited to participate in the study. Participants were divided into three groups: those vaccinated for less than a month, those vaccinated for 1–3 months, and those vaccinated for more than 3 months. A paired t-test served for statistical analysis.ResultsOverall, 171 out of 235 students (72.77%) completed the questionnaire, among which 90 individuals were fully vaccinated, and were included in the data analysis. Stress levels decreased (mean difference = −1.23, p-value = 0.002) and sleep quality and quantity improved mostly 1–3 months after the vaccination (mean difference = −0.5, p-value = 0.016). However, TMD symptoms were mostly alleviated in people vaccinated for more than 3 months (mean difference = −2.86, p-value <0.05). In this respect, no significant difference was observed between the two genders.Conclusion According to the results of the study, vaccination was associated with the improvement of psychological consequences of the COVID-19 pandemic. It is recommended that further longitudinal studies be conducted on larger sample sizes and different age groups by using various data collection methods (especially regarding the assessment of TMD).
... Está estabelecido na literatura que ansiedade, depressão, estresse percebido e estados de humor são fatores de risco importantes para o desenvolvimento ou cronicidade das DTMs (de La Torre Canales et al., 2018;Fillingim et al., 2013;Fillingim et al., 2018;Greene & Manfredini, 2021;Kindler et al., 2012;Manfredini et al., 2009;Yap et al., 2021;Yap et al., 2022). A pandemia de coronavírus tem o potencial de causar efeitos significativos no estado psicoemocional dos indivíduos podendo se relacionar diretamente com o surgimento de DTMs (Carrillo-Diaz et al., 2022;Cerqueira et al., 2021;Emodi-Perlman et al., 2020;Saczuk et al., 2022;). ...
Article
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A pandemia de COVID-19 e suas medidas de contenção influenciaram diretamente na saúde psicossocial dos indivíduos podendo acarretar no surgimento ou agravamento dos sinais e sintomas de disfunções temporomandibulares (DTMs). Dessa forma, os objetivos do presente estudo foram avaliar o impacto da pandemia nos sinais e sintomas de DTMs e a influência da infecção pelo novo coronavírus nesses sinais e sintomas. Trata-se de uma pesquisa observacional transversal com abordagem quantitativa, realizada na população do estado de Sergipe e do Distrito Federal. Baseado no Diagnostic Criteria for Temporomandibular Disorders DC/TMD, os indivíduos responderam via Google forms ao Questionário de Sintomas do DC/TMD e aos Dados Demográficos do DC/TMD. Participaram do estudo 244 indivíduos, 123 do estado de Sergipe e 121 do Distrito Federal. Destes indivíduos, 70,8% sentiram dor na mandíbula, têmpora, no ouvido ou na frente do ouvido e 64,2% relataram presença de dor na região temporal nos últimos 30 dias. Hábitos ou manias como apertar ou ranger os dentes e mastigar chiclete, alteraram a dor da maior parte dos entrevistados (50,8%). Não foi encontrada associação significativa (p≥0,05) entre as questões do Questionário de Sintomas do DC/TMD e a contaminação por COVID-19 entre os entrevistados. Desse modo, sugere-se que a pandemia pode ter impactado nos sinais e sintomas de DTMs na população de Sergipe e do Distrito Federal, mas a infecção pelo novo coronavírus não influenciou nestes sinais e sintomas, não sendo encontrada diferença significativa entre os indivíduos que foram ou não infectados.
... De La Torre Canales et al. observed severe somatization and depression in patients with TMD in a systematic review [5]. TMD symptoms influence oral health-related quality of life and psychological suffering. ...
Article
The present study evaluates the effect of rehabilitating completely edentulous patients with complete denture prosthesis on temporomandibular disorders (TMD). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to perform this systematic review, primarily to describe the technique. Manuscripts published between 1965 and December 31, 2021, were searched in the two most common electronic databases, PubMed and Cochrane Library. To find relevant scientific papers on the influence of complete dentures on temporomandibular disorders, an electronic pursuit of peer-reviewed articles confined to the English language and a dental survey were undertaken. Two observers reviewed the abstracts separately and chose five full-text papers that met the inclusion requirements. Due to the heterogeneity of the data provided, a meta-analysis could not be performed. The result of complete dentures on temporomandibular problems was studied in detail in five peer-reviewed papers. The result of the present study concluded that the complete denture could act as a conducive treatment option to the revocation of TMD for elderly edentulous patients.
... More specifically, headaches and neck pain/stiffness are symptoms of many physical (e.g., fatigue, exertion, etc.) and medical (e.g., hormonal, vascular, neurological, etc.) conditions that may not be related to TMDs. Furthermore, among the three TMD risk factors incorporated, only psychological factors were found to be positively associated with TMDs [30]. Based on current literature, the causal relationship between malocclusion and TMDs is not supported and the relationship between sleep/awake bruxism and TMDs is still inconclusive [31,32]. ...
Article
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Objective: This study aimed to develop/evaluate the psychometric properties of the Arabic Fonseca Anamnestic Index (FAI-A) and estimate the prevalence of TMDs in prospective orthodontic patients. Methods: The FAI-A was derived by forward-backward translation/cross-cultural adaption of the English FAI. Psychometric assessment of the FAI-A was performed with 308 orthodontic patients. Reliability was established via internal consistency and test-retest techniques, whereas, validity was verified by construct and convergent validity. Results: Cronbach's alpha value for the FAI-A was 0.77, and the intraclass correlation coefficient was 0.99. For construct validity, the distribution of eigenvalues indicated that three items (mouth opening difficulty, jaw movement difficulty, and jaw fatigue) accounted for 60.5% of the total variance observed. For convergent validity, the FAI-A items were significantly correlated to the global question. Conclusion: The FAI-A showed good reliability/validity and may be useful for screening TMDs. About 17% of prospective orthodontic patients presented with moderate-to-severe TMD symptoms.
... In turn, previous studies showed that TMD patients exhibited higher level of psychological disorders such as anxiety and depression compared with healthy controls (9)(10)(11). Patients with self-reported TMD-pain reported higher scores for anxiety, depression, and somatic symptoms compared to patients with no TMD-Pain complaint (12). ...
Article
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Background Emotion and quality of life may have been impacted by the coronavirus disease 2019 (COVID-19) crisis, especially in the lockdown. The impact of temporomandibular disorders (TMD) symptoms and tooth loss on mental status and Oral Health-Related Quality of Life (OHRQoL) are not fully understood in a stressful situation. Objectives We aimed to investigate whether TMD and tooth loss were the impaired risks of psychological states and OHRQoL in COVID-19 lockdown, and attempt to explore other potential risk factors. Methods This cross-sectional study surveyed residents via an online self-reported questionnaire, when Yangzhou was in lockdown. Demographic data, clinical information, the level of anxiety, depression and OHRQoL were collected and analyzed. Results Painful TMD symptoms and tooth loss are the risks of more severe anxiety and depression. TMD symptoms and tooth loss worsened OHRQoL. Lower education degree (OR: 6.31, P = 0.019), TMD-related pain symptoms (OR: 10.62, P = 0.005), tooth loss (OR: 3.12, P = 0.035), sleep disorders (OR: 2.92, P = 0.049) and relatively close contacts (OR: 3.95, P = 0.020) were verified as risk factors for increased level of anxiety. With respect to depression, low socio-economic status (OR: 6.22, P = 0.021), TMD-related pain (OR: 7.35, P = 0.012), tooth loss (OR: 4.48, P = 0.009), sleep disorders (OR: 5.13, P = 0.007) and relatively close contacts (OR: 12.94, P = 0.001) were identified as independent factors for developing depression. Additionally, drinking (B: −2.584, P = 0.013) and never going to the dental clinic (B: −3.675, P = 0.024) were relevant to better OHRQoL, while TMD without pain (B: 2.797, P = 0.008), TMD-related pain (B: 12.079, P < 0.001), tooth loss (B: 2.546, P = 0.006), sleep disorders (B: 2.598, P = 0.003) were independent factors for impaired OHRQoL. Conclusion Painful TMD symptoms, tooth loss and sleep disorders were the impaired risks of psychological states. TMD symptoms and tooth loss damaged OHRQoL when the city was in lockdown. Therefore, individualized psychological counseling is supposed to maintain control of mental health and OHRQoL under the stressful event.
... Temporomandibular joint related pain recorded a 0.7% increase to 1.6% of complaints during the pandemic period compared to pre-pandemic period as a result of increased stress and anxiety arising from the uncertainties associated with the pandemic [18]. In addition, psychological disturbances are identified risk factors for the development of temporomandibular disorders [19]. Overall, pain related conditions were commonly observed during the pandemic probably due to their emergency nature. ...
Article
Full-text available
Background: COVID-19 infection, declared pandemic by WHO in January 2020 constituted a public health problem due to the highly infectious nature of the disease and the subsequent lockdown imposed by the government to control the spread. Dental services delivery was severely affected.
... Among individuals with widespread pain, approximately 75% report pain also in the orofacial region [16,17]. Patients with widespread pain and painful TMD share comorbidities, such as perceived stress [18], somatic symptoms [19], sleep disturbances [20], and depression [21], in addition to their chronic pain condition. Taken together, a multifaceted overlap between painful TMD and widespread pain is firmly established. ...
Article
Full-text available
Objectives: Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. Materials and methods: Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20-69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain. Results: Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62-9.05 and OR 11.62 95% CI 5.18-27.88, respectively). Conclusion: These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.
... Temporomandibular joint related pain recorded a 0.7% increase to 1.6% of complaints during the pandemic period compared to pre-pandemic period as a result of increased stress and anxiety arising from the uncertainties associated with the pandemic [18]. In addition, psychological disturbances are identified risk factors for the development of temporomandibular disorders [19]. Overall, pain related conditions were commonly observed during the pandemic probably due to their emergency nature. ...
... 5,6 A 'biopsychosocial model of illness' was posited for the pathoetiology of TMDs and supported by the high occurrence of psychological distress and somatisation among individuals with TMDs. [7][8][9] The contemporary Diagnostic Criteria for TMDs (DC/TMD) standard stratify common TMD problems into pain-related (mostly arthralgia and myalgia) and intra-articular (mainly temporomandibular joint [TMJ] disc displacements, degenerative joint disease and subluxation) conditions. 10 Similarly, the five primary indicators of TMDs as specified by the Symptom Questionnaire (SQ) of the DC/TMD could be categorised into pain-related and intra-articular symptoms. ...
Article
Objectives: This study examined the three-dimensional impact of pain-related and/or intra-articular Temporomandibular disorder (TMD) symptoms and ascertained the inter-relationships between the functional, pain, and psychosocial aspects of oral health-related quality of life (OHRQoL). Methods: Young adults were enlisted from a local university and TMD symptoms were assessed with the Diagnostic Criteria for TMDs Symptom Questionnaire (DC/TMD-SQ). Participants were stratified into those with no (NT), pain-related (PT), intra-articular (IT), and mixed (MT) TMD symptoms. OHRQoL was examined using the Oral Health Impact Profile-14 (OHIP-14), and dimensional effects (oral function [OF], orofacial pain [OP], and psychosocial impact [PI]) were established subsequently. Data were evaluated with Kruskal-Wallis, Dunn, and Wilcoxon signed-rank tests (α = 0.05). Results: The mean age of the participants (n = 1205) was 19.7 ± 1.3 years (71.8% women). While 42.2% reported no TMD symptoms, 22.3%, 16.9%, and 18.5% had PT, IT, and MT accordingly. The MT, PT, and IT groups presented higher total OHIP-14 and dimension scores than the NT group (p <0.01). Scores were also significantly different between the MT and IT groups except for OF. For all TMD groups, the ranking of dimensional impact was OP > PI > OF, and associations between the OP and PI dimensions were the strongest (correlation coefficient [rs ] = 0.57-0.76). Conclusions: Young adults with PT and/or IT symptoms have poorer OHRQoL, especially in the OP and PI dimensions, which were moderate to strongly correlated. The use of the three dental Patient-reported Outcome (dPRO) dimensions could provide construct equivalency among OHRQoL measures.
... 4 The Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) study has reported a 4% incidence per year of first onset of TMD. 1 TMD has been linked to many comorbidities including fibromyalgia, irritable bowel syndrome, and depression, additionally to trauma and stress symptoms. 1,[5][6][7][8][9] Significantly higher prevalence of psychosocial factors such as somatic awareness, distress, catastrophizing, pain amplification, and psychosocial stress in subjects with TMD symptoms compared to healthy individuals, was observed in the OPPERA study. 1,10 Our group have previously reported increased saliva levels of stress hormones together with increased psychometric scoring, decreased pain thresholds and catastrophizing as predictors for TMD. ...
Article
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Purpose: To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables. Patients and methods: The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package. Results: Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor (OR = 5.79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up. Conclusion: High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores.
... Furthermore, it has been suggested that peripheral and central neural mechanisms are involved in the orofacial inflammatory pain states (Sessle, 2011(Sessle, , 2021Chichorro et al., 2017). Additionally, psychosocial components may also contribute to these conditions (Cairns, 2010;De La Torre Canales et al., 2018;Canales et al., 2019;Ettlin et al., 2021). ...
Article
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Objective: Moringa oleifera possesses multiple biological effects and the 4-[(4′-O-acetyl-α-L- rhamnosyloxy) benzyl] isothiocyanate accounts for them. Based on the original isothiocyanate molecule we obtained a semisynthetic derivative, named 4-[(2′,3′,4′-O-triacetyl-α-L-rhamnosyloxy) N-benzyl] hydrazine carbothioamide (MC-H) which was safe and effective in a temporomandibular joint (TMJ) inflammatory hypernociception in rats. Therefore, considering that there is still a gap in the knowledge concerning the mechanisms of action through which the MC-H effects are mediated, this study aimed to investigate the involvement of the adhesion molecules (ICAM-1, CD55), the pathways heme oxygenase-1 (HO-1) and NO/cGMP/PKG/K+ATP, and the central opioid receptors in the efficacy of the MC-H in a pre-clinical study of TMJ pain. Methods: Molecular docking studies were performed to test the binding performance of MC-H against the ten targets of interest (ICAM-1, CD55, HO-1, iNOS, soluble cGMP, cGMP-dependent protein kinase (PKG), K+ATP channel, mu (μ), kappa (κ), and delta (δ) opioid receptors). In in vivo studies, male Wistar rats were treated with MC-H 1 μg/kg before TMJ formalin injection and nociception was evaluated. Periarticular tissues were removed to assess ICAM-1 and CD55 protein levels by Western blotting. To investigate the role of HO-1 and NO/cGMP/PKG/K+ATP pathways, the inhibitors ZnPP-IX, aminoguanidine, ODQ, KT5823, or glibenclamide were used. To study the involvement of opioid receptors, rats were pre-treated (15 min) with an intrathecal injection of non-selective inhibitor naloxone or with CTOP, naltrindole, or norbinaltorphimine. Results: All interactions presented acceptable binding energy values (below −6.0 kcal/mol) which suggest MC-H might strongly bind to its molecular targets. MC-H reduced the protein levels of ICAM-1 and CD55 in periarticular tissues. ZnPP-IX, naloxone, CTOP, and naltrindole reversed the antinociceptive effect of MC-H. Conclusion: MC-H demonstrated antinociceptive and anti-inflammatory effects peripherally by the activation of the HO-1 pathway, as well as through inhibition of the protein levels of adhesion molecules, and centrally by μ and δ opioid receptors.
... 4 The Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) study has reported a 4% incidence per year of first onset of TMD. 1 TMD has been linked to many comorbidities including fibromyalgia, irritable bowel syndrome, and depression, additionally to trauma and stress symptoms. 1,[5][6][7][8][9] Significantly higher prevalence of psychosocial factors such as somatic awareness, distress, catastrophizing, pain amplification, and psychosocial stress in subjects with TMD symptoms compared to healthy individuals, was observed in the OPPERA study. 1,10 Our group have previously reported increased saliva levels of stress hormones together with increased psychometric scoring, decreased pain thresholds and catastrophizing as predictors for TMD. ...
Article
Objectives To examine the precision of imaging measures commonly used to assess mandibular morphology in children and adolescents with juvenile idiopathic arthritis (JIA). Secondly, to compare cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) in the measurement of condylar height. Methods Those included were children diagnosed with JIA during 2015–18 who had had an MRI, a CBCT of the temporomandibular joints (TMJs) and a lateral cephalogram (ceph) of the head within one month of each other. Agreement within and between observers and methods was examined using Bland-Altman mean-difference plots and 95% limits of agreement (LOA). A 95% LOA within 15% of the sample mean was considered acceptable. Minimal detectable change (MDC) within and between observers was estimated. Results 90 patients (33 males) were included, with a mean age of 12.8 years. For MRI, intra- and interobserver 95% LOA were relatively narrow for total mandibular length: 9.6% of the sample mean. For CBCT, condylar height, both intra- and interobserver 95% LOA were wide: 16.0 and 28.4% of the sample mean, respectively. For ceph, both intra- and interobserver 95% LOA were narrow for the SNA-angle and gonion angle: 5.9 and 8% of the sample mean, and 6.2 and 6.8%, respectively. Conclusions We have identified a set of precise measurements for facial morphology assessments in JIA, including one MRI-based (total mandibular length), one CBCT-based (condylar height), and three ceph-based. Condylar height was higher for MRI than for CBCT; however, the measurement was too imprecise for clinical use. MDC was also determined for a series of measurements.
... The etiology of TMDs is highly complex and adheres to a "biopsychosocial model" of illness [6]. Moderate-to-severe depression and somatization were observed in 21.4-60.1% and 28.5-76.6% of TMD patients, respectively [7]. TMDs, especially painrelated disorders, have been found to impair both general and oral health-related quality of life (OHRQoL) [8,9]. ...
Article
Objective: This study translated/cross-culturally adapted the Fonseca Anamnestic Index (FAI) for temporomandibular disorders (TMDs) into Malay and psychometrically tested the Malay-FAI (FAI-M). Methods: The FAI-M was created according to international guidelines. Internal consistency/test-retest reliability were assessed with Cronbach's alpha/intra-class correlation (ICC) coefficients. Construct and convergent validity were appraised by relating the FAI-M to the Global Oral Health (GOH) questionnaire and Short-form Oral Health Impact Profile (S-OHIP) using Kruskal-Wallis and Spearman's rho correlation (α = 0.05). Results: Of the 243 participants enrolled, 54.7% (n = 133) had no TMDs, while TMDs were present in 45.3% (n = 110). The FAI-M presented very good internal consistency (α = 0.90) and test-retest reliability (ICC = 0.99). Theoretically predicted FAI-M score patterns matched the GOH categories, and strong correlations were discerned between FAI-M and S-OHIP (rs = 0.71). Conclusion: The FAI-M exhibited good psychometric properties and can be applied in Malay-speaking populations.
... The association between psychological distress (including depression, specific comorbid functional disorders, and anxiety) and TMD pain was investigated in some previous studies [58,59]. In the systematic review from De La Torre Canales et al., in which they included 14 studies investigating psychosocial impairment in TMD patients, the prevalence of medium to high somatic symptom severity varied from 28.5% to 76.6% and for moderate to severe depression from 21.4% to 60.1% [60]. It is important to emphasize that different study instruments for psychological distress were used in our study (i.e., PHQ-9 and PHQ-15) than in the study of De La Torre Canales et al., in which they utilized the instruments SCL-90-SOM and SCL-90-DEP, which could explain the differences in prevalence. ...
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This study aimed to characterize self-reported headaches because of problems with the teeth, mouth, jaws, or dentures (HATMJD) in chronic patients with temporomandibular disorders (TMDs) in order to compare their results with those of TMD patients without such headaches and to investigate the associations of HATMJD with depression, anxiety, physical symptoms, oral behaviors, and sleep quality. We conducted a case–control study on consecutive chronic TMD patients referred to the University Medical Center of Ljubljana, Slovenia. A self-reported HATMJD was extracted from item #12 in the 49-item version of the Oral Health Impact Profile questionnaire. Axis II instruments of the Diagnostic Criteria for TMD (i.e., for screening of depression, anxiety, specific comorbid functional disorders, and oral behaviors) and the Pittsburgh Sleep Quality Index were used in this study. In total, 177 TMD patients (77.4% women; mean age: 36.3 years) participated in this study; 109 (61.6%) patients were classified as TMD patients with HATMJD. TMD patients with at least mild depressive and anxiety symptoms, with at least low somatic symptom severity, and a high number of parafunctional behaviors had more HATMJD. Parafunctional behavior and sleep quality were the most prominent predictive factors of the occurrence of HATMJD. TMD patients with HATMJD have more psychosocial dysfunction, a higher frequency of oral behaviors, and poorer sleep quality than TMD patients without such headaches.
... Despite the already established relationship between psychosocial factors, such as anxiety and depression, and Temporomandibular Disorders (TMDs) (Afari et al., 2014;De La Torre Canales et al., 2018;Nazeri et al., 2018), there is a paucity of studies investigating how the COVID-19 pandemic and its possible psychosocial impacts could affect manifestations of orofacial pain and TMDs (Asquini et al., 2021;Emodi-Perlman et al., 2020;Gaş et al., 2021;Medeiros et al., 2020;Saccomanno et al., 2020;Vrbanović et al., 2020;Wu et al., 2021). These studies have an important temporal limitation, due to their cross-sectional design (Emodi-Perlman et al., 2020;Gaş et al., 2021;Medeiros et al., 2020;Saccomanno et al., 2020;Vrbanović et al., 2020;Wu et al., 2021), except for the recent longitudinal cohort study by Asquini, et al. (2021) (Asquini et al., 2021). ...
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The events related to the COVID-19 pandemic are having a strong impact on public mental health. However, there are few studies focusing on these aspects in patients with temporomandibular disorders (TMD). The aim of this study was to evaluate the painful intensity, distress and symptoms of post-traumatic stress disorder (PTSD) in a population with and without TMD during the COVID-19 pandemic. This case-control study evaluated electronic questionnaires from 197 participants (105 with TMD and 92 controls), that were carried out during and after the first lockdown due to COVID-19 pandemic. To assess the presence of possible TMD, painful intensity, distress, and PTSD symptoms the respective questionnaires were used: TMD Pain Screener, Numeric Rating Scale, Patient Health Questionnaire – 4 and PTSD Checklist - Civilian Version. TMD participants showed higher levels of distress during (p = 0.027) and after (p < 0.001) the lockdown compared to the control group. The TMD group also reported increased levels of distress in the post-lockdown period in relation to the period during the lockdown (p = 0.002), although the same intensity of pain was observed at both evaluated periods. Furthermore, participants with TMD were 3.91 × more likely to be female (CI 95% = 1.88-8.13) and 3.82 × more likely to show PTSD symptoms (CI95% = 1.61-9.08) after the lockdown. These data suggest that a pre-existing painful condition can lead to increased distress and symptoms of PTSD as a result of stressful situations, such as the COVID-19 pandemic lockdown.
... For instance, it was found that in patients with rheumatoid arthritis the functional disability assessed with the Health Assessment Questionnaire-Disability Index (HAQ-DI) at baseline was independently associated with an increased risk of pain flares over a 12 months period 24,70 . The GCPS is a widely used instrument to assess the global severity of chronic pain based on its related disability 29 , and it is probably one of the most frequently used among orofacial pain disorders [71][72][73][74] . To the best of our knowledge, no previous study investigated the influence of pain-related impact status on short-term jaw pain fluctuations in TMD cases. ...
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Temporomandibular disorders (TMD) patients can present clinically significant jaw pain fluctuations which can be debilitating and lead to poor global health. The Graded Chronic Pain Scale evaluates pain-related disability and its dichotomous grading (high/low impact pain) can determine patient care pathways and in general high-impact pain patients have worse treatment outcomes. Individuals with low-impact TMD pain are thought to have better psychosocial functioning, more favorable disease course, and better ability to control pain, while individuals with high-impact pain can present with higher levels of physical and psychological symptoms. Thereby, there is reason to believe that individuals with low- and high-impact TMD pain could experience different pain trajectories over time. Our primary objective was to determine if short-term jaw pain fluctuations serve as a clinical marker for the impact status of TMD pain. To this end, we estimated the association between high/low impact pain status and jaw pain fluctuations over three visits (≤ 21-day-period) in 30 TMD cases. Secondarily, we measured the association between jaw pain intensity and pressure pain thresholds (PPT) over the face and hand, the latter measurements compared to matched pain-free controls (n = 17). Jaw pain fluctuations were more frequent among high-impact pain cases (n = 15) than low-impact pain cases (n = 15) (OR 5.5; 95% CI 1.2, 26.4; p value = 0.033). Jaw pain ratings were not associated with PPT ratings ( p value > 0.220), suggesting different mechanisms for clinical versus experimental pain. Results from this proof-of-concept study suggest that targeted treatments to reduce short-term pain fluctuations in high-impact TMD pain is a potential strategy to achieve improved patient perception of clinical pain management outcomes.
... People with temporomandibular joint (TMJ) disorders are more susceptible to experiencing anxiety and depression [14]. Moreover, there were reports linking TMJ/preauricular pain, depression, and anxiety [21][22][23]. ...
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Background: a type D personality is a factor in a person's susceptibility to general mental stress, especially during the COVID-19 pandemic. Although many studies were conducted on the relationships among stressful situations, an individual's personality, depression, and the occurrence of various diseases, e.g., cardiovascular disease or cancer, there are no analogous data on people with temporomandibular disorders (TMDs). Aim: the assessment of TMDs and depression symptoms in students with type D personality. Material and methods: the research was carried out with the participation of 240 physiotherapy students. The study group (G1) consisted of 120 participants with type D personalities, the control group (G2) consisted of the same number of participants, without "stress" personalities. All subjects were assessed for the occurrence of TMD symptoms, as well as for depression and anxiety symptoms, using the Beck Depression Inventory (BDI), based on the proprietary questionnaire. Results: in students with type D personality symptoms, TMDs occurred significantly more often and in greater number (p = 0.00) than in those without stress personalities. The exception was the symptom of increased muscle tension, which showed no statistical difference (p = 0.22). Among the 240 respondents, depression was found in 128 people (53.3%). In the group of students with type D personalities, depression was significantly more frequent than in the group without type D personalities (p = 0.00). In participants with depression, TMD symptoms were more common, i.e., headaches, neck, and shoulder girdle pain, TMJ acoustic symptoms, increased masticatory muscle tension, teeth clenching, and teeth grinding. There was no significant difference between the incidence of depression and TMJ pain and jaw locking. There was a significant interaction between the occurrence of headaches and acoustic symptoms and the occurrence of depression. For headache and depression interactions, the OR was >1; based on the results, we may assume that a headache depends more on the occurrence of depression rather than it being a symptom of a TMJ disorder in people with type D personalities. Conclusion: type D personality and depression may contribute to the development of TMD symptoms.
... 54 Even though the usefulness of Axis II has been shown in the clinical setting, 55 a recent systematic review reported that most studies have been based on specific populations recruited in health care centers, not allowing a deeper insight into the psychosocial features that negatively influence TMD patients. 5 In addition, due to the few clinical trials on the subject, 15,16 the assessment of psychosocial features on TMD treatment in clinical studies is recommended in order to establish individualized approaches in the clinical setting. Finally, the low number of subjects presenting with combined myofascial TMD pain and arthralgia in the present study is related to the RDC/TMD protocol method, as this method diagnoses myofascial TMD pain with an acceptable validity but does not present desirable levels for the sensitivity and specificity for arthralgia, underestimating its rates. ...
Article
Aims: To determine the effects of botulinum toxin type A (BoNT-A) on the psychosocial features of patients with masticatory myofascial pain (MFP). Methods: A total of 100 female subjects diagnosed with MFP were randomly assigned into five groups (n = 20 each): oral appliance (OA); saline solution (SS); and three groups with different doses of BoNT-A. Chronic pain-related disability and depressive and somatic symptoms were evaluated with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II instruments at baseline and after 6 months of treatment. Differences in treatment effects within and between groups were compared using chi-square test, and pain intensity was compared using two-way ANOVA. A 5% probability level was considered significant in all tests. Results: Most patients presented low pain-related disability (58%), and 6% presented severely limiting, high pain related disability. Severe depressive and somatic symptoms were found in 61% and 65% of patients, respectively. In the within-group comparison, BoNT-A and OA significantly improved (P < .001) scores of pain-related disability and depressive and somatic symptoms after 6 months. Scores of the control group (SS) did not change significantly over time. In the between-group comparison, BoNT-A and OA significantly improved (P < .05) scores of all variables at the final follow-up when compared to the SS group. No significant difference was found between the BoNT-A and OA groups (P > .05) for all assessed variables over time. Conclusion: BoNT-A was at least as effective as OA in improving pain-related disability and depressive and somatic symptoms in patients with masticatory MFP.
... e etiology of TMD is complex and is closely related to immune factors, joint anatomical factors, occlusal factors, psychosocial factors (such as anxiety and depression), and physical symptoms [25]. Patients with TMD have a higher prevalence of moderate somatization and depression, while severe physical injury is not common [26]. Psychological and physical ailments caused by TMD result in a lower quality of life in patients [27]. ...
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Background: Temporomandibular joint disorders (TMDs) are a common and prevalent disease with main symptoms of pain, joint sounds, and mandibular movement disorders, which seriously affects the mental health and quality of life of the sufferers. In recent years, there have been an increasing number of studies utilizing warm needle acupuncture (WNA) for the treatment of TMD, and the quality of the studies has gradually improved. However, evidence from evidence-based medicine is lacking. This study aims to use a systematic review and meta-analysis method to understand the efficacy of WNA for the treatment of TMD. Methods and Analysis. We searched randomized controlled trials (RCTs) of WNA for the treatment of TMD from 9 electronic databases, including 5 English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE) and 4 Chinese databases (Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)) from their inception to May 2021. The included RCTs compared WNA with acupuncture, electroacupuncture, pharmacological therapy, or other therapies. And outcome indicators such as total effective rate and cure rate were assessed. All analyses were conducted using RevMan software V5.3 and Stata16. Measurement count data used the relative risk (RR) as the efficacy statistic, and each effect size was given its point estimate value and 95% confidence interval (CI). Results: The meta-analysis included 10 studies with a total of 670 patients, which included 340 patients in the experimental group and 330 patients in the control group. The data in this review showed that WNA is superior to treatments such as acupuncture alone, acupuncture therapy combined with TDP, drug therapy, and ultrasonic therapy in terms of effective rate (RR = 1.20; 95% CI, 1.06 to 1.35; and P = 0.003) and cure rate (RR = 1.82; 95% CI, 1.46 to 2.28; and P < 0.00001) for the treatment of TMD. Conclusions: This systematic review and meta-analysis provides new evidence for the effectiveness of WNA for the treatment of TMD. However, the above conclusions need to be further verified by multicenter prospective studies of larger samples and higher-quality RCTs. Protocol registration number: INPLASY202160030.
... Post-pandemic signs can be similar to post-traumatic stress syndrome. The presentation or exacerbation of symptoms of chronic orofacial pain will possibly be a reality for many people in post-traumatic circumstances (17,28,38,(46)(47)(48). ...
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Background: The COVID-19 pandemic, a disease caused by Sars-CoV-2, has become a worldwide stressor, especially as it represents a new viral infection, which spreads quickly and easily, without prior knowledge about vaccination, and absence, to this moment, of a medication that is totally effective against the disease. Objective: The aim of this observational study was to provide a general evaluation, through a questionnaire applied to students in the health field of the Federal University of Rio de Janeiro, on the psychological impacts and behavioral changes generated by the COVID-19 pandemic on oral health, especially the triggering or exacerbation of bruxism and temporomandibular disorders (TMD). Methods: In order to verify the impacts of the pandemic on the health of UFRJ healthcare students, a non-randomized survey was performed with 370 students. Results: It was found that 72% of the students had their sleep routine altered, 65% had greater difficulty in keeping their spirits up, there was a statistically significant increase in emotional stress, headaches, and daytime teeth clenching. Conclusion: It was possible to conclude that the outbreak of COVID-19 resulted in psychological, physiological and behavioral impacts on students.
... Over 50-40% of the world's population suffers from various joint pathologies, including jaw joint involvement [5,6] , which requires medical intervention by various specialists in various fields of medicine. And this shows an increasing psychological and social defect [7] . Symptoms temporomandibular disorder (TMD) The peak age of 20-40 years is often characterized by a lower prevalence in younger and older people [8] and a higher gender orientation in women with painful and depressive situations [9] . ...
Article
Aim: The aim of this study was to examine the articles of the new use of engineered tissues in the treatment problems of joint temporomandibular jaw. Materials and methods: In order to carry out this study, a review of all articles source, books, Medline (PubMed) and Google scholar with a focus on the issue of the use of engineered tissues in the temporomandibular disorders in the period of time 1990 to 2018 done. Results: Using the approach of engineered tissue for the different treatment of defects of temporomandibular joint disorders can be helpful is that to them out of there. Ability to build cartilage similar to cartilage naturally by way of a new provision has been. Also, to help gene therapy, cell therapy, reconstruction defect of osteocondral, Ramus even part of the condyle of the left with the ability to comply with part of the left and doing function properly with the remaining part of the use of cells from stem mesenchymal (MSCs). There are factors of growth and cytokine are and provide a scaffold made of polymeric bio- compatible and industries can be differentiated cells from stem mesenchymal to cells of chondrocytes and osteoblasts to cause it. Although they are tried on this is that more regeneration of muscle - Skeletal with the use of the technology and rehabilitation of cells to patients without using scaffolds. Conclusion: As a result of this study, the review showed that gives the engineered tissue can be replaced by the old treatment of Temporomandibular joint (TMJ) and reconstructed it be, that benefits such as reducing damage to places of and reduce the risk of rejection of links.
... Aufgrund der kleinen Kohortengröße der vierten Untersuchungswelle der ILSE wurde von einer Stratifizierung der Daten entsprechend potenzieller Kofaktoren für CMD-assoziierte Symptome wie z. B. psychosoziale Einflüsse [5], Okklusion [18] oder auch Bruxismus [1,21] abgesehen. Auf eine Verifizierung der Kiefergelenksymptome mittels MRT wurde aufgrund des erheblichen finanziellen und organisatorischen Mehraufwands und unter Berücksichtigung der verminderten Belastbarkeit der Senioren verzichtet. ...
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Zusammenfassung Hintergrund Kraniomandibuläre Dysfunktionen (CMD) können auch im hohen Alter auftreten. Die Prävalenz von CMD-Symptomen bei Senioren wurde bisher nur wenig untersucht. Ziel der Arbeit Ziel dieser Untersuchung war es, die Prävalenz von Symptomen einer CMD bei Senioren nach Befunderhebung mit den Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) zu bestimmen. Dabei sollten die Prävalenzwerte von jüngeren (60 bis 74 Jahren) und älteren (≥ 75 Jahre) Senioren verglichen werden. Material und Methoden Im Rahmen der Interdisziplinären Längsschnittstudie des Erwachsenenalters (ILSE) wurden Probanden nach repräsentativen Gesichtspunkten rekrutiert. Während der vierten Nachverfolgungswelle im Zeitraum von 2014 bis 2016 im Bereich des Studienzentrums Leipzig wurden die Probanden auf das Vorliegen von anamnestischen und klinischen CMD-Symptomen untersucht. Ergebnisse Anamnestische CMD-Symptome bei Senioren ( n = 192) waren v. a. durch Schmerzen im Gesichtsbereich (13,0 %) gekennzeichnet. Das häufigste klinische CMD-Symptom waren Kiefergelenkgeräusche mit einer Prävalenz bis zu 35,5 %. Frauen gaben anamnestisch häufiger Kopfschmerzen/Migräne an. Kiefergelenkgeräusche und eine limitierte Mundöffnung wurden klinisch häufiger bei weiblichen Teilnehmenden beobachtet. Statistisch signifikante Unterschiede zeigten sich bei dem Vergleich von jüngeren und älteren Senioren hinsichtlich der Prävalenz von Kopfschmerzen/Migräne, jedoch nicht bei klinischen Symptomen. Schlussfolgerung Anamnestisch werden Gesichtsschmerzen von 13,0 % der Senioren angegeben. Kiefergelenkgeräusche werden bei jedem dritten Älteren klinisch beobachtet. CMD-Symptome scheinen bei jüngeren und älteren Senioren im ähnlichen Maße ausgeprägt zu sein.
... For instance, previous findings show that 88.9% with FM and 28.5-76.6% with TMD (unknown sub-diagnosis) presented with moderate to severe somatic symptoms [39,40]. Somatic symptoms are common among FM patients and are also closely related to widespread pain and disability [41], which could explain its high comorbidity with FM found in our study, as well as in other studies. ...
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The impact of comorbidities in fibromyalgia (FM) and temporomandibular disorders (TMD) have been well documented, but whether TMD sub-diagnoses myalgia (MYA) and myofascial pain with referral (MFP) differ regarding comorbidity is unclear. We aimed to elucidate this by studying the presence and associations of comorbidities in FM, MFP and MYA. An extended version of the Diagnostic Criteria for TMD axis II questionnaire was used to examine demographics, pain and comorbidities in 81 patients with FM, 80 with MYA, and 81 with MFP. Patients with MFP and FM reported a higher percentage of irritable bowel syndrome (IBS), depression, anxiety, somatic symptoms, perceived stress, and insomnia compared to MYA. Patients with FM had more IBS, depression, and somatic symptom disorder versus MFP. After adjusting for confounding variables, participants with anxiety, somatic symptoms disorder, pain catastrophizing, and perceived stress, as well as a greater number of comorbidities, were more likely to have MFP than MYA, whereas FM participants were more associated with IBS, somatic symptoms and insomnia compared to MFP. The number of comorbidities was significantly associated with widespread pain but not pain duration, body mass index or being on sick leave. In conclusion, patients with MFP were more similar to those with FM regarding comorbidity and should be differentiated from MYA in clinical settings and pain management.
... Moreover, there is a significant relationship between painful TMD, depression and anxiety [18]. Psychological responses to threatening situations, such as those faced during the COVID-19 pandemic, can trigger a chain of events that culminate in higher levels of sympathetic activity in response to stress and a consequent hyper-excitability of primary afferent sensitive neurons responsible for the recognition and conduction of painful stimulus to the central nervous system [19]. ...
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COVID-19 outbreak may lead to major impacts in applied oral sciences. Remarkably, it could be expected that factors associated to pandemic may lead to a greater risk of developing, worsening and perpetuating TMD and its associated risk factors. This non systematic literature review aims to discuss how the COVID-19 pandemic can influence the emergence, maintenance or worsening of TMD worldwide. During epidemics: the number of people whose mental health is affected tends to be greater than the number affected by the infection, and fear increases anxiety and stress levels in healthy individuals; chronic pain patients probably not receipt important treatments; overuse of medications becomes frequent; there are manifestation of unconscious oral parafunctional habits and poor sleep quality. All these facts represent risk factors common to TMD. Dentists should be aware of these issues and adapt their practices to properly diagnose and treat these patients within a multifactorial approach, increasing the quality of life of these individuals.
Article
A 41-year-old woman was referred from her general medical practitioner for an assessment of her temporomandibular disorder (TMD) to the National Interdisciplinary Orofacial Pain Clinic in Bergen, Norway. Previously, the Norwegian Government Health Directorate had initiated an interdisciplinary program for TMD patients, the National TMD project. A collaboration between the Department of Oral and Maxillofacial Surgery and the Pain Clinic at Haukeland University Hospital formed this interdisci-plinary team with specialists from both the dental and the medical health services. 1
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Temporomandibular Joint Dysfunction (TMD) is an umbrella term that includes musculoskeletal and neuromuscular conditions affecting the temporomandibular joint. The present systematic review aimed to verify whether there is a specific association between TMD and anxiety. The searches were carried out in electronic databases, including PubMed, Scopus, Web of Science, and LILACS, without restrictions on publication date and language. The acronym PECO was used, whose participants (P) were humans exposed to TMD (E), compared to participants without TMD (C) and the presence of anxiety as an outcome (O). After the search retrieval, the duplicates were removed, and the articles were evaluated by title and abstract, following our inclusion and exclusion criteria; then, the papers were read and thoroughly assessed. After selection, the methodological quality was performed using the Newcastle-Ottawa Scale (NOS) for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the level of evidence. A total of 710 studies were found, and 33 articles were considered eligible and were included for the qualitative synthesis and the level of evidence assessment. The studies confirmed the association between anxiety and DTM, although there was a low certainty of evidence among the selected studies. Most articles showed a low risk of bias. Although the limitations of this systematic review, it suggested a significant association between anxiety and TMD, as well as highlights possible directions for future research.
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Statement of problem Temporomandibular disorders (TMDs) affect the muscles of mastication, the temporomandibular joint, and associated structures. They are generally classified as muscular or articular and are the main cause of pain in the orofacial region, eventually causing psychological problems. However, the real burden of psychological disorders is unknown. Purpose The purpose of this systematic review and meta-analysis was to assess the prevalence of psychological disorders in patients with TMDs. Material and methods The study was conducted through a bibliographic search carried out without initial limit until July 2021 in the following electronic databases: MEDLINE/PubMed, Scopus, and PsycINFO. Clinical observational studies investigating depression and somatization in patients with TMD diagnosed by the Diagnostic Research for Temporomandibular Disorders (RDC/TMD) criteria in muscular, articular, and disc disorders were included. A descriptive analysis of the included studies and a meta-analysis for the prevalence data were performed for the synthesis of evidence. Results A total of 2320 studies were found, of which 48 complete articles were assessed for eligibility and 22 were included in the analysis. The general prevalence of depression and moderate and severe somatization in patients diagnosed with TMD was estimated at 43.0% (95% confidence interval (CI), 36.0% to 50.0%) and 60.0% (95% CI 52.0 - 67, 0%). The average overall score for depression was estimated at 0.92 (95% CI, 0.69-1.15), being classified as moderate depression. The average overall score for somatization was estimated at 1.09 (95% CI, 0.81-1.36), being classified as severe somatization. All analyses showed high heterogeneity (I²>90%). Based on the quality assessment, 80.9% of studies included in the review had low to moderate risk of bias. Conclusions Patients with TMDs who seek clinical care show a high prevalence of depression and somatization.
Article
Objectives: This study examined the correlates between severity of Temporomandibular disorders (TMDs), emotional distress, and eudaimonic well-being. Subjects and methods: TMD severity, negative emotions, and eudaimonia were assessed with the Fonseca Anamnestic Index (FAI), Depression, Anxiety, Stress Scales-21 (DASS-21), and Psychological Well-being Scale-18 (PWBS-18) in a cohort of community young adults. Statistical evaluations were done with non-parametric tests/correlation and multivariate regression analyses (α = 0.05). Results: Amongst the 873 participants (mean age 19.8 ± 1.66 years), 40.7%, 49.0%, and 10.3% had no (NT), mild (MT), and moderate-to-severe (ST) TMD respectively. Significant differences in total-DASS, depression, anxiety, and stress were ST ≥ MT > NT. Significant variances in total-PWSB and self-acceptance were NT > MT > ST while that for environmental mastery, positive relations, and purpose in life were NT > MT, ST. An inverse relationship was discerned between total-DASS and total-PWBS (correlation coefficient = -0.54). The prospect of ST was increased by anxiety but reduced by positive relations and self-acceptance. Conclusions: Young adults with mild and moderate-to-severe TMD experienced substantially higher emotional distress and lower eudaimonia than those with no TMD. As emotional distress and eudaimonic well-being are interrelated, positive psychological interventions may be beneficial for managing TMD-related psychosocial disabilities.
Article
PurposeThe study aims at finding the incidence of temporo-mandibular joint disorders (TMDs) in a non-patient population and relates their association with psychological distress and parafunctional habits.Materials and MethodsA DC/TMD questionnaire and DASS-21 scale survey were completed by selected participants followed by clinical examination of TMDs symptoms in sample population.ResultsA study sample of 855 participants revealed 36.65% population with various TMDs symptoms, while 63.5% population had no TMDs symptoms. 50.8% study participants were men, and 49.2% were women. Of all affected population, 16.2% had pain-related TMDs, 12.39% had intra-articular TMDs symptoms, and 8.07% had TMJ pain associated with pain or dysfunction. For all TMDs symptoms groups, the strongest correlations were for depression, while no significant associations were observed with parafunctional habits in all groups.Conclusions Overall psychological distress and anxiety increased the prospects of TMDs symptoms. Clinical factors like muscle tenderness, crossbite and deep vertical overlap seem to be significant etiological factors, while angle molar relationship and parafunctional habits do not seem to be significant etiologic factors in TMDs.
Article
Objective: To investigate the presence/severity of TMDs among Asian youths and examine the associations between TMD severity, otologic, and concomitant pain symptoms. Methods: Youths (17-24 years old) were recruited from a local polytechnic. The presence/severity of TMDs was determined with the Fonseca Anamnestic Index (FAI), while otologic/concomitant pain symptoms were appraised with the Maciel's Symptoms Checklist (MSC). Demographic, FAI, and MSC data were evaluated using Kruskal Wallis, chi-square, and relevant post-hoc tests (α = 0.05). Results: Among the participants (n = 200) enrolled, 40.5% had no TMD, whereas mild, moderate, and severe TMD were present in 43.5%, 12.5%, and 3.5%, respectively. Participants with moderate/severe TMDs had significantly more otalgia, tinnitus, vertigo, dizziness, ear pruritus, hearing loss, ear fullness, headache, eye, neck, and back pain than those with no TMDs (p < 0.001). Conclusion: Otologic and concomitant pain symptoms were associated with TMDs and appear to increase with progressive TMD severity.
Article
Objective: To assess representative psychosocial features in a group of temporomandibular disorder (TMD) patients from Jordan using Axis II of the Diagnostic Criteria for TMD (DC/TMD) protocol. Methods: Ninety-eight TMD patients were examined according to Axis I DC/TMD protocol in addition to assessment of their pain-related disability, psychological distress, and stress reactivity. Results: Just under half of the patients (49%) had high intensity of characteristic pain (self-reported TMJ-related pain) and one-third (32%) had high levels of pain-related disability. Furthermore, significant proportions of patients expressed moderate-severe degrees of distress and stress reactivity (41% and 39%, respectively). Significant correlations were identified between the Graded Chronic Pain Scale (GCPS) and each of the pain-related TMD subgroups. Conclusion: TMD patients are susceptible to high levels of pain-related psychosocial impairment, and clinicians should be aware of the possible correlations between the physical TMD diagnosis and specific psychosocial features during treatment planning.
Article
Background: The evidence on the relationship between anxiety and depression and patients with distinct subtypes of temporomandibular disorder (TMD) is uncertain, so a thorough review study on the topic is still missing. Objectives: This systematic review investigated the distribution and severity of anxiety and depression in patients diagnosed with different subtypes of TMD. Methods: The study is registered in PROSPERO (CRD42020150562) and it followed the PRISMA 2020 Statement. We searched in PubMed, Web of Science, Scopus, and SciELO databases (last search: 12 March 2021) and the reference list from the included studies. Study eligibility criteria consisted of: (i) patients diagnosed with TMD using the Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) instruments; (ii) assessment of anxiety and/or depression with validated psychological instruments; and (iii) allocation of patients into a minimum of two distinct TMD subtypes with at least one group having myofascial pain (comparison group). Analyses were carried out using RevMan 5.3.5 statistical package and random- or fixed-effects models (α=0.05). The quality of evidence was assessed based on review authors' judgment derived from a 10-item appraisal tool for prevalence studies and with the Newcastle-Ottawa Scale. Results: Out of the 4,086 records identified in total, 24 were eligible for inclusion; meta-analyses were conducted with 20 studies. In total, 3,678 subjects were included in the review. Most of the studies found that patients with myofascial pain showed similar occurrence and severity of anxiety/depression as compared to other subtypes of TMD, although the average prevalence seemed to be higher among the diagnoses consisting of myofascial pain (muscular TMD). Despite the moderate-to-high heterogeneity, anxiety and depression were more frequently distributed within patients with myofascial pain (p=0.001). TMD patients without myofascial pain presented less severe levels of anxiety and depression than patients with only myofascial pain (p≤0.01). The type of psychological instrument seems to affect the assessment of both anxiety and depression emotional states. Conclusion: The findings of this review suggest that patients with myofascial pain are more anxious and more depressed than patients with other subtypes of TMD. Implications: Considering that anxiety and depression are differently distributed within the TMD population, a proper assessment of the psychological state of patients seems essential to offer an adequate treatment and management of each specific subtype of TMD.
Article
Objective: The relation of degenerative temporomandibular joint (TMJ) diseases (DJDs) with sleep and emotional disturbance were investigated. Methods: CBCT examination of patients (n = 358) with DC/TMD-defined intra-articular temporomandibular disorders was performed and stratified into NN: no DJD and no arthralgia; NA: no DJD with arthralgia; TO: osteoarthrosis; and TR: osteoarthritis. Sleep and emotional disturbance were assessed with the Pittsburgh Sleep Quality Index (PSQI) and Depression Anxiety Stress Scale-21 (DASS-21). Data were evaluated using non-parametric and multivariate logistic regression analyses (α = 0.05). Results: Distributions of NN, NA, TO, and TR groups were 23.2%, 27.1%,19.0%, and 30.7%, respectively. No significant differences in total-PSQI/DASS scores were detected among the four groups. The presence of pain and stress predicted poor quality sleep with odds ratios of 10.75 and 1.07, accordingly. Conclusion: Sleep quality was affected more by arthralgia and stress than the presence of TMJ DJDs.
Article
The high prevalence of temporomandibular joint osteoarthritis (TMJOA), which causes joint dysfunction, indicates the need for more effective methods for treatment and repair. Mandibular condylar cartilage (MCC), a typical fibrocartilage that experiences degenerative changes during the development of TMJOA, has become a research focus and therapeutic target in recent years. MCC is composed of four zones of cells at various stages of differentiation. The cell subsets in MCC exhibit different physiological and pathological characteristics during development and in TMJOA. Most studies of TMJOA are mainly concerned with gene regulation of pathological changes. The corresponding treatment targets with specific cell subsets in MCC may provide more accurate and reliable results for cartilage repair and TMJOA treatment. In this review, we summarized the current research progress on the cell subsets of MCC from the perspective of MCC development and degeneration. We hope to provide a reference for further exploration of the pathological process of TMJOA and improvement of TMJOA treatment.
Article
The novel coronavirus are found to affect the ACE2 receptors in the epithelial cells of the lining of the respiratory tract. Since live virus have been found in the saliva of infected patients, and ACE2 receptors are present in epithelial lining of salivary glands and tongue, there are chances that the virus might affect the oral cavity and hence might have oral manifestation. The aim of the study was to determine and evaluate the presence of oral symptoms in the patients infected with the 2019 Novel Coronavirus (Covid 19). In this cross sectional descriptive study, a set of questionnaires was MATERIALS AND METHODS: formulated and the patients who have come to covid screening centers in Kamrup Metro region were interviewed for both oral symptoms and general symptoms. A total of 467 patients were evaluated. The samples were divided according to covid positive or negative. Group 1: Covid positive (+ve); Group 2: Covid negative (- ve). Out of which Group 1 had 287 patients whereas Group 2 had 180 patients. Upon statist RESULTS: ical analysis, signicant differences were found with respect to fever, cough, breathing difficulty, sore throat, arthralgia, and asthenia where covid positive patients found to have a high prevalence of these symptoms. On evaluation of the of the oral symptoms in both covid positive and negative patients signicant differences were found viz., burning sensation, swollen gums , changes in taste sensation, pain in the TMJ and bleeding gums with covid positive patients having more predilection of having all these symptoms. On evaluation of the gender predilection between positive patients with symptoms, positive patients without symptoms and negative patients with symptoms , there found to be no signicant difference. oral CONCLUSION symptoms of burning sensation, changes in taste sensation , bleeding gums and pain in the TMJ are found to be more prevalent with patients having corona virus infection.
Article
Objective To evaluate the prevalence/severity of somatic and temporomandibular disorder (TMD) symptoms in Southeast Asian youths and determine their associations with psychological distress. Methods Demographic information, Patient Health Questionnaire-15 (PHQ-15), Fonseca Anamnestic Index (FAI), and Depression, Anxiety, Stress Scale-21 (DASS-21) responses were gathered electronically and analyzed using non-parametric statistical and logistic regression analysis (p < 0.05). Results Of 400 youths (mean age 18.7 ± 1.7 years; 52.3% females), 65.0%/47.0% reported somatic/TMD symptoms, and 10.5% had TMDs. Significant differences in psychological distress were observed among the varying severity of somatic/TMD symptoms. Correlations between PHQ-15/FAI and DASS-21 scores were weak to moderately strong (rs = 0.30–0.61). Stepwise logistic regression indicated that female gender, TMD symptoms, and stress were risk factors for somatic symptoms, while somatic symptoms and stress were probable factors for TMDs. Conclusion Somatic and TMD symptoms are common in Southeast Asian youths and may be a manifestation of psychological distress.
Article
Statement of problem Although psychological disorders have been established as one of the etiological factors for temporomandibular disorders, anxiety levels in individuals with masticatory muscle pain before and during the coronavirus 2019 (COVID-19) pandemic have not previously been compared. Purpose The purpose of this clinical study was to evaluate anxiety levels in patients with masticatory muscle pain at times before and during the COVID-19 pandemic. Material and methods Eighty patients (18 to 68 years) with masticatory muscle pain were included in the study. All participants had completed the Generalized Anxiety Disorder 7 questionnaire (GAD-7) before the first COVID-19 infection had been reported in Turkey. After the onset of the COVID-19 pandemic, all participants were contacted by telephone to repeat the GAD-7 to evaluate changes in their psychology during the first lock-down. However, 18 of the 80 patients were unreachable. A statistical analysis was performed by using the Mann-Whitney U test. Proportion comparisons between sociodemographic characteristics and GAD-7 levels were performed by using the Fisher exact test (α=.05). Results Forty-eight (60%) of the study population were women, 32 (40%) were men, with a mean age ±standard deviation of 36.63 ±13.85 years. Both before and during pandemic GAD-7 scores were statistically similar as was each demographic parameter, including sex, educational status, and occupational status (P>.05). Also, no significant correlation was recorded between age and before and during pandemic GAD-7 global scores (r=-0.098 and r=-0.052, respectively, P>.05). However, during pandemic GAD-7 scores were statistically higher than before pandemic GAD-7 scores (P<.001). Conclusions Demographic parameters had no connection with anxiety levels in patients with masticatory muscle pain before and during the COVID-19 pandemic periods. However, the COVID-19 pandemic anxiety levels in the participants were higher compared with levels before the pandemic.
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Introduction: Orofacial pain is a critical TMD symptom that can influence physical and social capacity. Objective: To evaluate the association of temporomandibular disorders (TMD) symptoms with affective relationships and demographic variables in young adults. Material and method: A cross-sectional study involving 395 young adults was developed. Diagnostic Criteria for TMD, anxiety, and depression were collected from questionnaires. The Dental Health Component of the Index of Orthodontic Treatment Need measures the orthodontic treatment need. Questionnaires also contained questions related to the previous orthodontic treatment. Logistic regression models were adjusted, estimating crude odds ratio with the 95% confidence intervals. The variables with p<0.20 in the analyses were assessed in a multiple logistic regression model, remaining with p≤0.10. Result: There was no significant association of TMD symptoms with sex, age, medication use for pain, previous orthodontic treatment, orthodontic treatment need, anxiety, and depression (p>0.05). Individuals without an affective relationship are 1.78 (95%CI: 0.99-3.17) times more likely to report TMD symptoms. Conclusion: Affective relationships showed an association with TMD symptoms in young adults.
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Aims Temporomandibular disorders (TMD) are often associated with psychological comorbidities. One such comorbidity is pain catastrophizing, i.e., exaggeration of negative consequences of a painful event. The aim was to investigate catastrophizing in individuals with painful TMD compared to controls and the association between catastrophizing and pain intensity, number of pain sites and functional limitations. Methods A community-based sample of 110 individuals (83 women; 20-69 yrs) with painful TMDs (myalgia/arthralgia as per Diagnostic Criteria for TMD), and 190 age- and gender-matched controls (119 women; 20-69 yrs) from the Public Dental services in Västerbotten, Sweden participated. Associations between catastrophizing and functional jaw limitations, respectively, and painful TMD were evaluated with ordinal regression. adjusted for the effect of gender and age. Associations (Spearman’s correlation) of the Pain Catastrophizing Scale (PCS) with Jaw Functional Limitation Scale (JFLS-20), pain site number (whole body pain map), and characteristic pain intensity (CPI) and intergroup comparisons (Mann-Whitney U test) of these variables were also calculated. Results Levels of catastrophizing, were associated with TMD pain (OR 1.6, 95%CI 1.1-2.6). Among individuals with painful TMD, catastrophizing was correlated to pain intensity (r=0.458, p<0.01) and functional limitations (r=0.294-0.321, p≤0.002), but not to number of pain sites. Conclusion Compared to controls, community-based individuals with painful TMD demonstrated higher levels of pain catastrophizing, and this catastrophizing was associated with increased pain intensity and jaw dysfunction. The relatively low scores of pain catastrophizing suggest that even mild catastrophic thinking is associated with pain perception and jaw function, and should be considered in patient management.
Article
Objectives This study examined the metric properties of the Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD) using Factor/Rasch analyses and created a short-form version of the measure. Subjects and Methods Aggregated OHIP-TMD data were obtained from a cross-sectional study involving 844 TMD patients with Diagnostic Criteria for TMDs defined conditions. The dimensionality of the OHIP-TMD was first evaluated with Exploratory Factor Analysis. An eigenvalue >1.0 and oblique oblimin rotation were applied for extracting the factors. Rasch analysis was subsequently performed on the primary dimension using the ConQuest software. Results Multi-dimensionality of the OHIP-TMD was observed with the primary dimension comprising ten items. Adequate fit to the Rasch model was noted after deleting item 8 with infit/outfit mean square values ranging from 0.75 to 1.40 logits. Item difficulty ranged from -0.75 to 1.05 logits, while participants’ ability to respond varied from -4.55 to 5.19 logits. The respondent spread was slightly skewed and satisfactory item-response targeting was present. Conclusions The 22-item OHIP-TMD demonstrated multi-dimensionality with the primary dimension consisting of nine reliable items with adequate fit to the Rasch model. The 9-item short-form version of the OHIP-TMD (SOHIP-TMD) is a promising tool for evaluating OHRQoL.
Article
Objectives: This study established the diagnostic accuracy of the Fonseca Anamnestic Index (FAI) in relation to the Diagnostic Criteria for TMD (DC/TMD) standard.Methods: A total of 866 TMD patients and 57 TMD-free controls were instructed to answer the FAI and DC/TMD Symptom Questionnaire (SQ). Participants were subsequently categorized into no (NT), pain-related (PT), and/or intra-articular (IT) TMDs using the DC/TMD protocolized examination/algorithms. Receiver operating characteristics (ROC) curves, best cut-off points, and accuracy measures were determined.Results:The FAI demonstrated high accuracy for detecting all TMDs, PT, and IT (AUC = 0.96–0.98). The best cut-off points were 22.50 for all TMDs/IT and 27.50 for PT. Sensitivity of the FAI was high (94.23–98.21%), but specificity was moderate (87.72%) for all diagnostic categories.Discussion:The diagnostic accuracy of the FAI for identifying pain-related and intra-articular TMDs was high. FAI scores ≥25 points should be used to screen for TMDs.
Article
Objective The associations between the presence of differing severity/form of temporomandibular disorder (TMD) symptoms and oral health-related quality of life (OHRQoL) were explored. Methods The severity and form of TMDs in young adults were categorized based on the Fonseca Anamnestic Index (FAI) and Diagnostic Criteria for TMDs (DC/TMD), and OHRQoL was assessed with the Oral Health Impact Profile-14 (OHIP-14). Data were analyzed using non-parametric statistics (α = 0.05). Results The study cohort consisted of 501 young adults (mean age 19.7 ± 1.3 years; 75.2% women). Participants with severe/moderate TMDs had significantly higher OHIP severity scores than those with mild/no TMDs. Moreover, participants with combined/pain-related symptoms exhibited significantly higher severity scores compared to those without symptoms. The physical pain and psychological discomfort domains were typically more impaired regardless of severity/form of TMD symptoms. Conclusion More severe and painful symptoms were related to greater impairments in OHRQoL, especially in the physical and psychological domains.
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Objective: To assess the frequency and age distribution of Axis I and Axis II diagnoses among Polish patients with temporomandibular disorders (TMD). Method: One hundred sixty-three (n = 163) consecutive adult patients seeking TMD treatment were assessed based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines. Descriptive statistics on the frequency of diagnoses and mean age of the diagnostic groups was performed. Result: Frequency of muscle disorders, disc displacements, and other joint disorders was 56.9, 48.9, and 31%, respectively. Disc displacement was the most common diagnosis in younger patients. Severe somatization and depression were shown in 11.9 and 15.8% of patients, respectively. Only 10.5% of the patients showed severe pain-related impairment. Females tended to have higher psychosocial scores than males. Discussion: The frequency of Axis I TMD diagnoses in Polish patients is similar to other populations, whereas Axis II findings slightly differ from previous reports from other countries.
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The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.
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Classification of most chronic pain disorders gives emphasis to anatomical location of the pain to distinguish one disorder from the other (e.g., back pain versus temporomandibular disorder [TMD]) or to define subtypes (e.g., TMD myalgia versus arthralgia). However, anatomic criteria overlook etiology, potentially hampering treatment decisions. The present study identified clusters of individuals using a comprehensive array of biopsychosocial measures. Data were collected from a case-control study of 1,031 chronic TMD cases and 3,247 TMD-free controls. Three subgroups were identified using supervised cluster analysis (referred to as the adaptive, pain-sensitive, and global symptoms clusters). Compared to the adaptive cluster, participants in the pain-sensitive cluster showed heightened sensitivity to experimental pain, and participants in the global symptoms cluster showed both greater pain sensitivity and greater psychological distress. Cluster membership was strongly associated with chronic TMD: 91.5% of TMD cases belonged to the pain-sensitive and global symptoms clusters whereas 41.2% of controls belonged to the adaptive cluster. TMD cases in the pain-sensitive and global symptoms clusters also showed greater pain intensity, jaw functional limitation, and more comorbid pain conditions. Similar results were obtained when the same methodology was applied to a smaller case-control study consisting of 199 chronic TMD cases and 201 TMD-free controls. During a median 3-year follow-up period of TMD-free individuals, participants in the global symptoms cluster had greater risk of developing first-onset TMD (hazard ratio=2.8) compared to participants in the other two clusters. Cross-cohort predictive modeling was used to demonstrate the reliability of the clusters.
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Purpose: The primary objective of this study was to assess the prevalence of temporomandibular disorders (TMDs) and comorbid factors (sleep bruxism and headaches). This study was a cross-sectional population survey in the city of Maringá, state of Paraná, Brazil. Materials and methods: Axes I and II of the Research Diagnostic Criteria for TMD (RDC/TMD) were used for assessment of TMD signs and symptoms. The population was users of the Brazilian public health system (SUS), of both sexes, between the ages of 20 and 65 years, and not seeking treatment for TMD. Results: The selected population (N = 1,643) was composed mostly of (a) women (65.9%), (b) married or single individuals (90.6%), (c) Caucasians (70.1%), (d) individuals aged 32.7 ± 10.3 years, (e) individuals earning a medium income (75.1%), and (f) those who had completed a high school education or higher (79.9%). According to the chronic pain grade classification (CPG) in the RDC/TMD Axis II, 36.2% of the population had some degree of TMD pain (CPG I to IV); however, only 5.1% had severe limitation due to pain (CPG III or IV). In the RDC/TMD Axis I diagnoses, 29.5% presented with muscle disorders (group I), 7.9% with disk displacements (group II), and 39.1% with other joint disorders (group III). Headaches were present in 67.9% and awake and sleep bruxism in 30% and 33.4% of the population, respectively. Conclusion: The prevalence of signs and symptoms of TMD was high in this population, but with low disability; however, the proportion of patients in need of treatment was much lower.
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AIMS: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. METHODS: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. RESULTS: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. CONCLUSION: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
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To test whether patients with temporomandibular disorder (TMD) pain differ from subjects from the general population with regard to their stress-related coping styles. Consecutive adult TMD patients (n = 70) and adult subjects of a regional general population sample (n = 868), examined according to the German version of the Research Diagnostic Criteria for TMD (RDC/TMD), were included in this study. The inclusion criterion for TMD patients was at least one pain-related diagnosis according to the RDC/ TMD, while general-population subjects were excluded if they had any pain-related TMD diagnosis. Coping styles were assessed using a common and well-accepted German 114-item stress-coping questionnaire ("Stressverarbeitungsfragebogen" SVF 114). The coping style-TMD pain relationship was investigated using logistic regression analyses adjusted for possible confounders (age, sex, level of education), as well as the influence of psychosocial measures (RDC/TMD Axis II). Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Study participants who used fewer adaptive coping styles (OR = 0.47, CI: 0.26-0.83) and more maladaptive coping styles (OR = 1.55, CI: 1.05-2.29) were at greater risk for TMD pain. After adjustment for sociodemographic confounders, the coping style-TMD pain relationship changed only slightly in magnitude. In an analysis adjusted for sociodemographic confounders and psychosocial RDC/TMD Axis II measures, adaptive coping styles were even more profoundly related to TMD pain (OR: 0.27, 95 CI: 0.09-0.83), but maladaptive coping styles were less related to TMD pain (OR: 1.17, 95% CI: 0.51-2.72). Differences in the applied stress-related coping styles of TMD patients and subjects without TMD may have implications for clinical decision making and choosing among treatment alternatives.
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The aim of the study was to evaluate the association between psychosocial aspects of temporomandibular disorders (TMD) and oral health-related quality-of-life (OHRQoL) and, secondly, to investigate the gender differences in these associations using patient and non-patient groups. The sample of the study consisted of 79 patients with TMD and 70 non-patients. The data was collected by Finnish versions of the RDC/TMD Axis II profile and Oral Health Impact Profile (OHIP-14) questionnaires. The associations between Axis II profile sub-scales and OHIP prevalence were evaluated using chi-square tests, as stratified by group status (TMD patients and non-patient controls) and by gender. The association between OHIP prevalence and Axis II profile sub-scales were evaluated using logistic regression analysis, adjusted by age, gender and group. OHIP prevalence (those reporting at least one problem) was 90.9% in the patient group and 33.3% in the non-patient group (p < 0.001, chi-squared test). OHIP prevalence was higher among those scoring higher on all RDC/TMD Axis II profile sub-scales, i.e. graded chronic pain status, depression and non-specific physical symptoms with pain items included and with pain items excluded. The associations were significant in the non-patient group. Women showed statistically significant associations of OHIP prevalence with all Axis II sub-scales. Among men, OHIP prevalence associated with GCPS and somatization. The logistic regression analysis showed that OHIP prevalence associated significantly with somatization and depression. TMD associate with OHRQoL through multiple ways, linked with depression and somatization. These findings emphasize the importance of early and effective treatment of TMD.
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To examine whether psychological variables such as depression and non-specific physical symptoms (somatization) influence pain entity among acute and chronic TMD patients with one or more TMD diagnoses (muscle disorders, MD; disc displacements, DD; and arthralgia, arthritis, arthrosis, AAA). One hundred and fifty-four patients (37 male and 117 female; mean age, 39.0 +/- 14.5 years) with Research Diagnostic Criteria for Temporomandibular Disorders (RDC/ TMD) protocol were selected. Differences in mean depression and somatization scores between acute and chronic TMD patients, as well as TMD patients with one or multiple TMD diagnoses were compared by using the parametric T-test for independent samples. The majority of patients were acute TMD patients (81.8%), while the remaining 28 patients (18.2%) were chronic TMD patients. 62% of patients had only one TMD diagnosis (MD or DD or AAA), 31% of patients had two diagnoses (MD+DD, MD+AAA, DD+AAA) and, finally, 7% of patients had three diagnoses (MD+DD+AAA) according to the RDC/TMD protocol. According to the SCL-90 psychometric evaluation, 19.5% of patients presented a severe depression score (> 1.105), 27.3% of participants presented a severe somatization score with pain items included (> 1.000). The results of the t-test for independent samples showed statistically significant differences between acute and chronic TMD patients (p < 0.001), as well as between patients who were assigned one diagnosis (p = 0.019) and patients who had two or more diagnoses (p < 0.001); for mean levels of depression and somatization scores. Chronic TMD patients and patients with multiple TMD diagnoses had higher rates of depression and somatization in this study. These results could be used in a tailored strategy of TMD treatment.
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As part of an ongoing multicenter investigation involving four highly specialized tertiary clinics for temporomandibular disorders (TMD) treatment, retrospective analysis of Research Diagnostic Criteria for TMD (RDC/TMD) axis I and axis II data gathered on clinic and community cases were assessed with a twofold aim: (1) to search for a correlation between axis I diagnoses and axis II pain-related disability, and (2) to identify clinical (axis I) and psychosocial (axis II) predictors of high pain-related disability. Two samples of patients seeking treatment for TMD (clinic cases, N = 1,312) and a sample of general population subjects (community cases, N = 211) underwent a thorough assessment in accordance with the RDC/TMD version 1.0 [1] guidelines to receive both axis I and axis II diagnoses. Spearman’s test was performed to assess the level of correlation between axis I diagnoses and Graded Chronic Pain Scale (GCPS) pain-related disability. A stepwise multiple logistic regression model was used to identify the significant associations between 12 clinical and psychosocial predictors and the presence of high pain-related disability. Axis I findings were related with pain-related impairment (GCPS scores) in the overall study sample including both clinic community cases (Spearman correlation = 0.129, p = 0.000), but the results of the correlation analyses performed on the clinic sample alone were not significant (Spearman correlation = −0.018, p = 0.618). Predictors for high disability were related to axis II findings (severe depression and somatization) or psychosocial aspects related to the pain experience (pain lasting from more than 6 months; treatment-seeking behavior), while none of the axis I diagnoses remained in the final logistic regression model. The final model predicted the level of pain-related impairment at a fair level (R 2 = 26.7%). The correlation between axis I diagnoses and pain-related impairment is not significant in the patients populations. Treatment-seeking behavior and other factors related with the pain experience are likely to be more important than the physical findings to determine the degree of psychosocial impairment.
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The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Validation Project has provided the first comprehensive assessment of reliability and validity of the original Axis I and II. In addition, Axis I of the RDC/TMD was revised with estimates of reliability and validity. These findings are reported in the five preceding articles in this series. The aim of this article is to present further revisions of Axis I and II for consideration by the TMD research and clinical communities. Potential Axis I revisions include addressing concerns with orofacial pain differential diagnosis and changes in nomenclature in an attempt to provide improved consistency with other musculoskeletal diagnostic systems. In addition, expansion of the RDC/TMD to include the less common TMD conditions and disorders would make it more comprehensive and clinically useful. The original standards for diagnostic sensitivity ( < or = 0.70) and specificity (< or = 0.95) should be reconsidered to reflect changes in the field since the RDC/TMD was published in 1992. Pertaining to Axis II, current recommendations for all chronic pain conditions include standardized instruments and expansion of the domains assessed. In addition, there is need for improved clinical efficiency of Axis II instruments and for exploring methods to better integrate Axis I and II in clinical settings.
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To analyze the reliability, validity, and clinical utility of the depression, non-specific physical symptoms, and graded chronic pain scales comprising the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II. Data resulting from independent longitudinal and cross-sectional epidemiological studies as well as randomized clinical trials conducted at the University of Washington and the University at Buffalo were submitted to descriptive, correlational, and inferential statistical analyses to evaluate selected psychometric properties of the RDC/TMD Axis II scales. Analyses of available data from both TMD clinical centers revealed good to excellent reliability, validity, and clinical utility for the Axis II measures of depression, somatization, and graded chronic pain. Specifically, data were presented comparing the RDC/TMD depression scale to the Beck Depression Inventory and the Center for Epidemiologic Studies Depression Scale; these data supported concurrent validity of the RDC/TMD measure and its use as a depression screening tool. Its clinical utility lies in its demonstrated usefulness for alerting TMD clinicians to potentially noteworthy depressive symptomatology in TMD patients. Others have shown that elevated somatization, the tendency to report non-specific physical symptoms as noxious or troublesome, is a predictor of poor TMD treatment outcome. The present analyses demonstrated that the RDC/TMD Axis II non-specific physical symptoms scale has acceptable reliability and that severe levels of somatization can potentially confound interpretation of the Axis I clinical examination. The graded chronic pain scale was demonstrated to have clinical utility for tailoring TMD treatment to levels of a patient's psychosocial adaptation. The major RDC/TMD Axis II measures demonstrate psychometric properties suitable for comprehensive assessment and management of TMD patients.
Article
To answer a clinical research question: ‘is there any association between features of dental occlusion and temporomandibular disorders (TMD)?’ A systematic literature review was performed. Inclusion was based on: (i) the type of study, viz., clinical studies on adults assessing the association between TMD (e.g., signs, symptoms, specific diagnoses) and features of dental occlusion by means of single or multiple variable analysis, and (ii) their internal validity, viz., use of clinical assessment approaches to TMD diagnosis. The search accounted for 25 papers included in the review, 10 of which with multiple variable analysis. Quality assessment showed some possible shortcomings, mainly related with the unspecified representativeness of study populations. Seventeen (N = 17) articles compared TMD patients with non-TMD individuals, whilst eight papers compared the features of dental occlusion in individuals with TMD signs/symptoms and healthy subjects in non-patient populations. Findings are quite consistent towards a lack of clinically relevant association between TMD and dental occlusion. Only two (i.e., centric relation [CR]-maximum intercuspation [MI] slide and mediotrusive interferences) of the almost forty occlusion features evaluated in the various studies were associated with TMD in the majority (e.g., at least 50%) of single variable analyses in patient populations. Only mediotrusive interferences are associated with TMD in the majority of multiple variable analyses. Such association does not imply a causal relationship and may even have opposite implications than commonly believed (i.e., interferences being the result, and not the cause, of TMD). Findings support the absence of a disease-specific association. Based on that, there seems to lack ground to further hypothesise a role for dental occlusion in the pathophysiology of TMD. Clinicians are encouraged to abandon the old gnathological paradigm in TMD practice.
Article
Objectives: This case-control study aimed to compare patients with temporomandibular disorders (TMD) and healthy controls in terms of oral health-related quality of life (OHRQoL) considering Graded Chronic Pain Scale (GCPS) scores, pain duration, psychological impairment and demographic characteristics. Methods: A total of 75 patients with TMD and 75 healthy controls were recruited. The short version of Oral Health Impact Profile (OHIP-14) was administered for evaluating the OHRQoL. Psychosocial impairments were assessed using the General Health Questionnaire-28 (GHQ-28). The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I and II were also used for patient diagnosis and collecting GCPS scores, pain duration, age and gender. Independent-sample t tests, Pearson's chi-square tests and multiple logistic and linear regression models were applied for statistical analysis. Results: The mean age of the patients was 34.3±12.4 years. A female-to-male ratio of 6:1 was seen in the TMD group. The prevalence and severity of the OHIP were significantly different between the TMD and control groups (66.7% vs 12.0% and 18.0 vs 9.2, respectively). According to multiple logistic regression for OHIP prevalence and multiple linear regression for OHIP severity in the TMD group, GCPS scores and pain duration, followed by psychological impairment, were the most important predictors of the OHRQoL. Conclusion: TMD negatively affected the OHRQoL, particularly in patients with psychological impairments. Meanwhile, age and gender did not seem to have a serious effect. Hence, promoting the quality of life of patients with TMD requires emphasis on chronic pain management and maintaining good mental health.
Article
• We assessed multiple pain conditions and their association with affective disturbance, somatization, and psychological distress based on questionnaire data from a probability sample of 1016 enrollees of a large health maintenance organization. Respondents were asked about the presence of five pain conditions and were classified empirically in terms of dysfunctional chronic pain status based on pain severity, pain persistence, and painrelated disability days. Logistic regression analyses revealed a highly significant association between number of pain conditions reported and elevated levels of somatization as measured by the Symptom Checklist 90—Revised. Individuals with two or more pain conditions were at elevated risk of an algorithm diagnosis of major depression, while persons with a single pain condition did not differ from persons with no current pain conditions. Number of pain conditions reported was a better predictor of major depression than were important measures of pain experience, including pain severity and pain persistence.
Article
To use the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II and additional pain-related and psychosocial variables to identify subtypes of TMD patients in a primary health care setting based on pain-related disability. Consecutive TMD pain patients (n = 399) seeking treatment in a primary care setting completed a multidimensional pain questionnaire. Subtyping was based on the Graded Chronic Pain Scale (GCPS), and the patients were divided into a no-disability group (0 disability points), lowdisability group (1-2 disability points), and high-disability group (3-6 disability points). Psychosocial variables included RDC/TMD Axis II variables, anxiety, tension and stress, worry, catastrophizing, coping ability, general health, and other pain problems. Subtype differences were analyzed with t test, Wilcoxon rank-sum test, ANOVA, or Kruskal-Wallis test. A further analysis with multivariable logistic model was applied. All P values from pairwise comparisons were Bonferroni adjusted. Most (61%) of the patients belonged to the no-disability group, 27% to the low-disability group, and 12% to the high-disability group. When subtypes were compared, patients in the no-disability group appeared psychosocially well-functioning, with fewer symptoms related to psychosocial distress, better ability to control pain, and fewer jaw functional limitations and other pain problems. Patients in the high-disability group reported the highest levels of symptoms of depression and somatization, sleep dysfunction, worry, and catastrophizing thoughts. The low-disability patients formed an intermediate group between the no-disability and high-disability groups. The results suggest that GCPS-related disability scoring can be used as a simple screening instrument in primary care settings to identify individuals with different, clinically relevant psychosocial subtypes.
Article
To measure the effect of occlusal splints as an additional treatment on psychological aspects in temporomandibular disorder patients. A randomized controlled trial was performed comprising 60 adults diagnosed with masticatory myofascial pain according the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The participants were divided equally into 2 treatment groups, which received only counselling (Group 1) or occlusal splints in addition to counselling (Group 2). The assessments occurred at baseline and at 2 and 5 months after treatment. The outcomes were symptoms of anxiety and depression, as well as pain catastrophizing. Two-way ANOVA, Friedman and Mann-Whitney tests were used to perform the statistical analysis, considering a significance level of 5%. In relation to the baseline assessment, 60% of the subjects had at least mild anxiety and 25% had at least mild depression, and the mean and standard deviation (SD) of pain catastrophizing was 2.41 (1.33) for Group 1 and 2.06 (1.04) for Group 2. Comparisons between baseline and the fifth-month evaluation showed an improvement in anxiety and depression symptoms only in Group 2 (p<0.05). Otherwise, there was a significant reduction in pain catastrophizing in both groups (p<0.05), with a mean (SD) of 1.14 (1.28) for Group 1 and 0.76 (0.82) for Group 2. Minimally invasive strategies could provide an improvement in the psychological aspects of temporomandibular disorder patients, and the use of an occlusal splint seems to hasten the manifestation of these effects. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
Unlabelled: Case-control studies have consistently associated psychological factors with chronic pain in general and with temporomandibular disorder (TMD) specifically. However, only a handful of prospective studies have explored whether preexisting psychological characteristics represent risk factors for first-onset TMD. The current findings derive from the prospective cohort study of the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) cooperative agreement. For this study, 3,263 TMD-free participants completed a battery of psychological instruments assessing general psychological adjustment and personality, affective distress, psychosocial stress, somatic symptoms, and pain coping and catastrophizing. Study participants were then followed prospectively for an average of 2.8 years to ascertain cases of first-onset of TMD, and 2,737 provided follow-up data and were considered in the analyses of TMD onset. In bivariate and demographically adjusted analyses, several psychological variables predicted increased risk of first-onset TMD, including reported somatic symptoms, psychosocial stress, and affective distress. Principal component analysis of 26 psychological scores was used to identify latent constructs, revealing 4 components: stress and negative affectivity, global psychological and somatic symptoms, passive pain coping, and active pain coping. In multivariable analyses, global psychological and somatic symptoms emerged as the most robust risk factor for incident TMD. These findings provide evidence that measures of psychological functioning can predict first onset of TMD. Future analyses in the OPPERA cohort will determine whether these psychological factors interact with other variables to increase risk for TMD onset and persistence. Perspective: This article reports that several premorbid psychological variables predict first-onset TMD in the OPPERA study, a large prospective cohort study designed to discover causal determinants of TMD pain. Measures of somatic symptoms were most strongly associated with TMD onset, but perceived stress, previous life events, and negative affect also predicted TMD incidence.
Article
Aims: To perform a systematic review of the literature dealing with the prevalence of bruxism in adult populations. Methods: A systematic search of the medical literature was performed to identify all peer-reviewed English-language papers dealing with the prevalence assessment of either awake or sleep bruxism at the general population level by the adoption of questionnaires, clinical assessments, and polysomnographic (PSG) or electromyographic (EMG) recordings. Quality assessment of the reviewed papers was performed according to the Methodological evaluation of Observational REsearch (MORE) checklist, which enables the identification of flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. For each included study, the sample features, diagnostic strategy, and prevalence of bruxism in relation to age, sex, and circadian rhythm, if available, were recorded. Results: Thirty-five publications were included in the review. Several methodological problems limited the external validity of findings in most studies, and prevalence data extraction was performed only on seven papers. Of those, only one paper had a flaw less external validity, whilst internal validity was low in all the selected papers due to their self-reported bruxism diagnosis alone, mainly based on only one or two questionnaire items. No epidemiologic data were available from studies adopting other diagnostic strategies (eg, PSG, EMG). Generically identified "bruxism" was assessed in two studies reporting an 8% to 31.4% prevalence, awake bruxism was investigated in two studies describing a 22.1% to 31% prevalence, and prevalence of sleep bruxism was found to be more consistent across the three studies investigating the report of "frequent" bruxism (12.8% ± 3.1%). Bruxism activities were found to be unrelated to sex, and a decrease with age was described in elderly people. Conclusion: The present systematic review described variable prevalence data for bruxism activities. Findings must be interpreted with caution due to the poor methodological quality of the reviewed literature and to potential diagnostic bias related with having to rely on an individual's self-report of bruxism.
Article
The objective of this study was to describe the frequency of TMD diagnoses in a patient population for comparison with the available literature. Five hundred twenty consecutive patients seeking TMD treatment underwent a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) assessment. The prevalence and age distribution of the different RDC/TMD axis I and II diagnoses were described. Muscle disorders, disk displacements, and other joint disorders were diagnosed respectively in 56.4%, 42.0%, and 57.5% of patients. Sixty percent of patients had depression symptoms, 76.6% had somatization, and 21.8% presented high levels of pain-related impairment. Disk displacements were more frequently diagnosed in the younger-aged, other joint disorders in the older-aged, and muscle disorders in the middle-aged subjects (ANOVA for mean age comparison, F = 3.355; P = .002). These distribution frequencies of TMD diagnoses provide insight into the epidemiology of this disease.
Article
To assess the biopsychosocial factors associated with acute temporomandibular disorders (TMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Participants were assessed in community-based dental clinics and evaluated by trained clinicians using physical and psychosocial measures. A total of 207 subjects were evaluated. Patients' high-risk versus low-risk status for potentially developing chronic TMD was also determined. Analyses of variance and chi square analyses were applied to these data. Participants' characteristic pain intensity differed among RDC/TMD Axis I diagnoses. They also significantly varied in their self-reported graded chronic pain, depression, somatization (pain inclusive), somatization (pain excluded), and physical well-being. In addition, participants with differing RDC/TMD Axis I diagnoses varied in self-reported pain during their chewing performance. Finally, there were also significant differences in chewing performance between high-risk versus low-risk (for developing chronic TMD) patients. Participants with multiple diagnoses reported higher pain, as well as other symptoms, relative to participants without a TMD diagnosis. For chewing performance, participants with mutual diagnoses reported more pain compared to other participants. Finally, the risk-status of patients significantly affected chewing performance.
Article
The purpose of this study was to investigate the nonspecific physical and psychological symptoms in patients who suffered from temporomandibular joint disorder (TMD) using the Research Diagnosis Criteria (Axis II) for TMD diagnosis (RDC/TMD). A total of 317 patients were included (M: 75, F: 242). The signs and symptoms of physical, psychological and behavioral factors were evaluated using questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method and diagnosed by the same investigator. Patients were divided into 3 different groups such as: the osteoarthritis group (group 1), the internal derangement (group 2) and the myofascial pain dysfunction syndrome group (MPDS, group 3). In the analysis of depression and vegetative symptoms, patients in the internal derangement group revealed a high ratio of 'normal'. In patients with MPDS, they appeared to suffer highly. According to nonspecific physical symptoms, there have been tendencies of a higher ratio of 'severe' patients with MPDS. In subjects aged 25 years or younger, the internal derangement group was the greatest, while the osteoarthritis group was the greatest for subjects over 40-years old. In the evaluation of depression and vegetative symptoms, the internal derangement group showed a relative normal value while the MPDS group showed a serious extent in comparison. According to the result of this study, MPDS group showed more severe depressive and nonspecific physical symptoms than internal derangement group. When making TMD diagnosis and treatment, it is thought to be important to analyze psychometric properties and nonspecific physical symptoms.
Article
The present investigation attempts to describe the correlation between sleep-time masticatory muscle activity (MMA) and psychological symptoms by the use of a four-channel electromyography (EMG) home-recording device in a group of 15 healthy volunteers completing a battery of psychometric questionnaires for the assessment of anxiety, depression and anger. The integrated EMG signal was adopted to quantify the work (μV × s) produced by each of the four muscles (bilateral masseter and temporal) during the 5-h recording span and per each 1-h increment. The duration of MMA events and the muscle work during the first hour of sleep was related to trait anxiety scores for both masseter (P = 0·007) and temporalis muscles (P = 0·022). Trait anxiety was also significantly correlated to the total amount of MMA duration (in seconds) of the temporalis muscles (r = 0·558; P = 0·031). The present investigation provides support to the hypothesis that the duration of sleep-time masticatory muscle activity, especially during the early phases of a night's sleep, may be related to anxiety trait and not to anxiety state, depression or anger. These findings may support the view that features related to the individual management of anxiety, viz. trait, are likely to be more important than acute episodes of anxiety, viz. state, in the aetiology of sleep-time masticatory muscle activity. The role of other psychological symptoms is likely to be less important.
Article
The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II for psychosocial assessment was adopted to grade chronic pain severity and to correlate that severity with levels of depression and somatization in a population of chronic TMD patients. A series of 111 consecutive patients who sought treatment for TMD symptoms lasting longer than 6 months were recruited and underwent assessment using the RDC/TMD axis II instrument. The frequencies of the different scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90R Depression (SCL-DEP) and Somatization (SCL-SOM) scales in the study population were recorded. Correlation between categories of patients identified by the GCPS items and the SCL-DEP and SCL-SOM scales was assessed by means of the Spearman rank correlation test. Severe or moderate somatization was shown by 47.7% and 26.1% of patients, and severe or moderate depression scores were recorded by 39.6% and 1.8% of the sample, respectively. GCPS scores showed that the vast majority of patients had a low disability or no disability at all, with only 5.4% of patients showing a severely limiting high disability. A significant correlation was found between SCL-SOM and GCPS scores, but not between SCL-DEP and GCPS, even if raw depression scores of patients with a high disability were greater than those of subjects with a low disability. Within the limitations of the present investigation, the external validity of which is far from optimal and should be improved in future studies on more representative samples, the RDC/TMD axis II for psychosocial assessment has provided interesting data regarding the prevalence of the different degrees of chronic pain severity and their relation with levels of depression and somatization.
Article
To develop two checklists for the quality of observational studies of incidence or risk factors of diseases. Initial development of the checklists was based on a systematic literature review. The checklists were refined after pilot trials of validity and reliability were conducted by seven experts, who tested the checklists on 10 articles. The checklist for studies of incidence or prevalence of chronic disease had six criteria for external validity and five for internal validity. The checklist for risk factor studies had six criteria for external validity, 13 criteria for internal validity, and two aspects of causality. A Microsoft Access database produced automated standardized reports about external and internal validities. Pilot testing demonstrated face and content validities and discrimination of reporting vs. methodological qualities. Interrater agreement was poor. The experts suggested future reliability testing of the checklists in systematic reviews with preplanned protocols, a priori consensus about research-specific quality criteria, and training of the reviewers. We propose transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence.
Article
The relationship between the rate of chronic pain-related disability and depression and somatization levels as well as the influence of pain duration on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II findings were assessed in a three centre investigation. The study sample (N=1149; F:M 4.1:1, m.a. 38.6 years) consisted of patients seeking for TMD treatment and undergoing RDC/TMD axis II psychosocial assessment to be rated in chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression (Symptoms Checklist-90[SCL-90] scale for depression, DEP) and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM). The null hypotheses to be tested were that (1) no correlation existed between GCPS categories and DEP and SOM scores, and (2) no differences emerged between patients with pain from more or less than 6 months as for the prevalence of the different degrees of pain-related impairment, depression, and somatization. In the overall sample, the prevalence of high pain-related disability (GCPS grades III or IV), severe depression and somatization was 16.9%, 21.4%, and 28.5%, respectively. A correlation was shown between GCPS and both DEP and SOM categories (Spearman's correlation test, p<0.001). A significant association between pain lasting from more than 6 months and high GCPS scores was shown (chi(2), p<0.001), while no association was found between DEP and SOM scores and pain duration in the overall sample (chi(2), p=0.742 and p=0.364, respectively). Pain-related disability was found to be strongly related with depression and somatization levels as well as associated with pain duration. Depression and somatization scores were not associated with pain duration.
Article
The present paper aims to systematically review the literature on the temporomandibular disorders (TMD)-bruxism relationship published from 1998 to 2008. A systematic search in the National Library of Medicine's PubMed database was performed to identify all studies on humans assessing the relationship between TMD symptoms and bruxism diagnosed with any different approach. The selected articles were assessed independently by the 2 authors according to a structured reading of articles format (PICO). A total of 46 articles were included for discussion in the review and grouped into questionnaire/self-report (n = 21), clinical assessment (n = 7), experimental (n = 7), tooth wear (n = 5), polysomnographic (n = 4), or electromyographic (n = 2) studies. In several studies, the level of evidence was negatively influenced by a low level of specificity for the assessment of the bruxism-TMD relationship, because of the low prevalence of severe TMD patients in the studied samples and because of the use of self-report diagnosis of bruxism with some potential diagnostic bias. Investigations based on self-report or clinical bruxism diagnosis showed a positive association with TMD pain, but they are characterized by some potential bias and confounders at the diagnostic level (eg, pain as a criterion for bruxism diagnosis). Studies based on more quantitative and specific methods to diagnose bruxism showed much lower association with TMD symptoms. Anterior tooth wear was not found to be a major risk factor for TMD. Experimental sustained jaw clenching may provoke acute muscle tenderness, but it is not analogous to myogenous TMD pain, so such studies may not help clarify the clinical relationship between bruxism and TMD.
Article
The consequences of a disease or condition such as temporomandibular disorders (TMD) include functional limitation and psychosocial disability. These two concepts refer to the individual's experience of limitations in function associated with the affected part of the body and to disarray in one's life, respectively. Models of disability emphasize the individual's self-report in describing these states and the centrality of these concepts as part of the disease and illness process. However, assessment approaches typically used in medicine and especially in dentistry do not yet routinely include these domains. TMD, as a musculoskeletal pain condition, can clearly lead to both limitation and disability, and the available evidence suggests that dentofacial disorders can also lead to both consequences. The relatively low contribution of disease impairment (measured changes in function through objective tests), however, to the reported limitation or disability in either TMD or dentofacial disorders remains complex and poorly understood. This article reviews the overall model of disablement, the necessary properties of measures to assess disablement, the present state of knowledge about these concepts, and what measures should be considered as part of routine assessment.
Article
The prevalence of temporomandibular disorders (TMD) is higher among women than men, indicating a multifactorial role for gender-related differences in the etiology of TMD: physiological hormonal differences, inflammatory response to stress, and sociocultural differences in response to pain. The aim of this study was to draw a biobehavioral picture of the TMD patient based on Research Diagnostic Criteria for TMD (RDC/TM) Axis II diagnosis and analysis of gender-related differences. Between January 2006 and January 2008, 362 subjects were consecutively enrolled from patients who presented at the Clinic for Temporomandibular Disorders, School of Dental Medicine, University of Pavia, because of orofacial pain, limitation or joint sounds on mandibular movement. Of the 362 subjects evaluated, 308 met the inclusion criteria. The average age of the study population was 41 years; the female: male ratio was 4:1. When stratified according to chronic pain intensity grade and gender, 26% of the women had grade I, 36.4% grade II, 17% grade III, and 9.7% grade IV; 34.4% of the men had grade I, 32.8% grade II, 6.5% grade III, and 3.3% grade IV. Depression was moderate in 35 women and in 6 men and severe in 138 women and in 24 men; somatization was moderate in 59 women and in 20 men and severe in 143 women and in 19 men. Gender-related differences may be considered risk factors for TMD; psychological characteristics, including somatization, depress