Influence of Psychological Factors on Risk of Temporomandibular Disorders

Australian Research Centre for Population Oral Health, Dental School, University of Adelaide, SA 5005, Australia.
Journal of Dental Research (Impact Factor: 4.14). 11/2007; 86(11):1120-5. DOI: 10.1177/154405910708601119
Source: PubMed


Psychological characteristics potentially may be a cause or consequence of temporomandibular disorder (TMD). We hypothesized that psychological characteristics associated with pain sensitivity would influence risk of first-onset TMD, but the effect could be attributed to variation in the gene encoding catechol-O-methyltransferase (COMT). We undertook a prospective cohort study of healthy female volunteers aged 18-34 yrs. At baseline, participants were genotyped, they completed psychological questionnaires, and underwent quantitative sensory testing to determine pain sensitivity. We followed 171 participants for up to three years, and 8.8% of them were diagnosed with first-onset TMD. Depression, perceived stress, and mood were associated with pain sensitivity and were predictive of 2- to 3-fold increases in risk of TMD (P < 0.05). However, the magnitude of increased TMD risk due to psychological factors remained unchanged after adjustment for the COMT haplotype. Psychological factors linked to pain sensitivity influenced TMD risk independently of the effects of the COMT haplotype on TMD risk.

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    • "The observed interaction is a novel finding. Previous prospective cohort studies of TMD either did not investigate genes (Von Korff et al. 1993; Aggarwal et al. 2010; Kindler et al. 2012; Plesh et al. 2012) or lacked statistical power to detect interactions (Slade et al. 2007). The finding is consistent with animal experimental and in vitro studies demonstrating that "
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    ABSTRACT: When measured once, psychological stress predicts development of painful temporomandibular disorder (TMD). However, a single measurement fails to characterize the dynamic nature of stress over time. Moreover, effects of stress on pain likely vary according to biological susceptibility. We hypothesized that temporal escalation in stress exacerbates risk for TMD, and the effect is amplified by allelic variants in a gene, catechol-O-methyltransferase (COMT), regulating catechol neurotransmitter catabolism. We used data from the Orofacial Pain: Prospective Evaluation and Risk Assessment prospective cohort study of 2,707 community-dwelling adults with no lifetime history of TMD on enrollment. At baseline and quarterly periods thereafter, the Perceived Stress Scale (PSS) measured psychological stress. Genotyped DNA from blood samples determined COMT diplotypes. During follow-up of 0.25 to 5.2 y, 248 adults developed examiner-verified incident TMD. PSS scores at baseline were 20% greater (P < 0.001) in adults who developed incident TMD compared with TMD-free controls. Baseline PSS scores increased by 9% (P = 0.003) during follow-up in cases but remained stable in controls. This stress escalation was limited to incident cases with COMT diplotypes coding for low-activity COMT, signifying impaired catabolism of catecholamines. Cox regression models confirmed significant effects on TMD hazard of both baseline PSS (P < 0.001), modeled as a time-constant covariate, and change in PSS (P < 0.001), modeled as a time-varying covariate. Furthermore, a significant (P = 0.04) interaction of COMT diplotype and time-varying stress showed that a postbaseline increase of 1.0 standard deviation in PSS more than doubled risk of TMD incidence in subjects with low-activity COMT diplotypes (hazard ratio = 2.35; 95% confidence limits: 1.66, 3.32), an effect not found in subjects with high-activity COMT diplotypes (hazard ratio = 1.42; 95% confidence limits: 0.96, 2.09). Findings provide novel insights into dynamic effects of psychological stress on TMD pain, highlighting that effects are most pronounced in individuals whose genetic susceptibility increases responsiveness to catecholamine neurotransmitters. © International & American Associations for Dental Research 2015.
    No preview · Article · Jul 2015 · Journal of dental research
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    • "Otro de los factores oclusales identificado es el síndrome de masticación habitual de un lado [28], para el cual existe la hipótesis de que el ser humano tiene un lado preferido para realizar la masticación y este es el lado que presenta mayor alteración de la atm [29] [30]. Esto constituye un factor nervioso central [36], de modo que la regulación y el control del dolor se remontan a niveles superiores e incluso a factores genéticos. "

    Full-text · Article · May 2015
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    • "Facial pain that originates from the musculoskeletal structures of the masticatory system is included to be one symptom of TMD [5]. TMD has a multifactorial background, with structures, occlusion, craniofacial morphology, function, trauma, stress and psychological factors as possible risk or contributing factors, the importance of occlusion in TMD etiology being still under debate [6] [7] [8] [9] [10] [11]. "
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    ABSTRACT: The aim was to evaluate the relationships of changes in facial pain, temporomandibular disorders (TMDs) and oral health-related quality-of-life (OHRQoL) in adults who underwent orthodontic or orthodontic/surgical treatment. Sixty-four patients (46 women, 18 men, range 18-64 years) with severe malocclusion and functional problems were treated in Oulu University Hospital. Of these, 44 underwent orthodontic-surgical and 20 orthodontic treatment. Data were collected with questionnaires and clinical stomatognathic examinations before and on average 3 years after treatment. The OHRQoL was measured with OHIP-14 (The Oral Health Impact Profile), the intensity of facial pain with the Visual Analogue Scale (VAS) and the severity of TMD with the Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indices. A significant improvement was found in facial pain, signs and symptoms of TMD and OHRQoL after the treatment (p < 0.05). The decrease in VAS was associated with improvement in OHIP-14 severity (r = 0.296, p = 0.019). The correlations between changes in OHIP-14 severity and Ai and Di were not statistically significant. Treatment of severe malocclusion seemed to improve OHRQoL via decreased facial pain. Decreased facial pain was associated especially with improved OHRQoL dimensions of physical pain, physical disability and social disability.
    Full-text · Article · May 2015 · Acta odontologica Scandinavica
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