Psychosocial behaviour and health care utilization in patients suffering from temporomandibular disorders diagnosed on the basis of clinical findings and MRI examination

Head and Neck Pain Drawing Area Correlates With Higher Psychosocial Burden But Not With Joint Dysfunction in Temporomandibular Disorders: A Cross-Sectional Study

Head and neck pain drawings have been introduced as part of the diagnostic gold standard for temporomandibular disorders (TMD). We aimed to quantify the spatial extent of pain in TMD patients and to analyze its association with further clinical findings. In a cross-sectional study, 90 patients (median age = 38 years; n women = 68) were diagnosed according to the DC/TMD. Intra-articular disorders were either confirmed or rejected by magnetic resonance imaging. The patients shaded all painful areas in a sketch of the left and right side of a face. A grid template was placed over the drawings and each region that contained markings was scored as painful. The correlation between the calculated area and the psychosocial variables (DC/TMD axis II) as well as the influence of pain lateralization were investigated using Spearman correlation, Mann-Whitney-U and chi-square tests. Pain affected all facial areas but concentrated on the regions of the temporomandibular joint and masseter origin. Thirty-nine percent reported purely unilateral pain, which was associated with structural TMJ findings in 77% of cases. Individuals with bilateral pain and those with greater spatial spread of pain had significantly higher scores on all axis II variables, except for functional limitation of the jaw. PERSPECTIVE: Head and neck pain drawings can contribute to a stratification of TMD patients. A greater extent of pain as well as pain bilateralization is associated with higher levels of emotional distress, pain chronicity and somatization, but not with functional impairment. Unilateral reporting of pain is associated with more intra-articular disorders.

Sleep-associated aspects of myofascial pain in the orofacial area among Temporomandibular Disorder patients and controls

STUDY OBJECTIVES

To assess sleep-associated aspects of temporomandibular disorder (TMD) with myofascial pain (MP) in the orofacial area of patients and controls.

MEASUREMENTS

Three hundred five female patients were screened to find 44 participants fulfilling the inclusion criteria, 22 suffering from MP and 22 in a control group. Sleep quality was assessed by use of the Pittsburgh Sleep-Quality-Index (PSQI) and a validated German sleep questionnaire (SF-AR). Tooth wear was assessed and anterior temporalis muscle activity was measured at home for several nights by use of a portable electromyography (EMG) device.

RESULTS

22 patients (45.0 ± 13.6 years) and 22 controls (45.2 ± 9.0 years) were recruited. The PSQI sum-score was 7.5 ± 3.7 for patients and 4.4 ± 3.0 for controls (p = 0.006). The SF-AR showed that 23% of the controls and 14% of the patients were "long sleepers". The overall number of episodes in the two groups was not significantly different (4.10 ± 2.65 versus 4.57 ± 1.99 episodes per hour). However, more patients had temporalis muscle activity possibly related to SB during all four consecutive nights (p = 0.04). According to the International Classification of Sleep Disorders - Third Edition (ICSD-3) criteria, 13.6% of the controls and 71.4% of the patients (p < 0.001) showed SB.

CONCLUSIONS

Sleep-associated disturbances, including reduction of sleep quality and greater prevalence of SB and facial pain in the morning, occurred significantly more often among TMD patients. Additionally, SB fluctuated over the nights especially in controls. This should be taken into consideration when the prevalence of SB is assessed by use of EMG.

Anxiety and depression in patients with chronic temporomandibular pain and in controls

OBJECTIVES

The purpose of this study was to assess the prevalence of anxiety and depression in temporomandibular disorders (TMD) patient subgroups and in controls with or without chronic facial pain (CFP).

METHODS

Our sample consisted of 61 men and 161 women. All TMD patients had suffered from pain for at least 6 months and were divided into two subgroups-an exclusively myofascial pain group and an exclusively joint pain group. Subjects without signs or symptoms of TMD but with and without CFP served as controls. All subjects were examined by calibrated examiners in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders. The German version of the Hospital Anxiety and Depression Scale was used for assessment of anxiety and depression. Analysis of covariance was used to determine the effects of sex, age, and subgroup on anxiety and depression scores. Additional t-tests were performed and the subgroups were then compared with those from a general population sample.

RESULTS

Females from the exclusively myofascial pain group were significantly more depressed than those from the general population or from the exclusively joint pain group. Male controls with CFP were significantly more depressed than female CFP controls. For anxiety, no significant effect of sex or subgroup was found.

CONCLUSIONS

Depression may play an important role in women with chronic myofascial pain whereas anxiety does not seem to be relevant for either females or males. Further anxiety screening of patients with temporomandibular pain could not be justified.

Influence of psychopathologies on craniomandibular disorders

Psychopathologies play a role in the etiology and maintenance of craniomandibular disorders (CMD). In this study, the craniomandibular index was applied to valuate signs and symptoms of CMD in 60 dentate patients, who were assigned to 2 groups: symptomatic (n=35) and asymptomatic (n=25). An interview on psychopathologies was carried out with the aim to detect the presence of some mood disorders, such as depression, dysthymic and bipolar I disorders. Among these disturbances, depression was the most significant aspect to be reported (p<0.05) since it was present in most symptomatic patients. This important interaction was also significantly correlated (p<0.05) with the Palpation Index. These results suggest that psychopathological aspects could increase muscle tenderness and pain in addition to sleep dysfuntions and other physical complaints. Therefore, psychopathologies should be regarded as an important aspect in patients with orofacial pains.

Evaluation of Low-Level Laser Therapy in the Treatment of Temporomandibular Disorders

OBJECTIVE

The purpose of this study was to assess the effectiveness of low-level laser therapy (LLLT) in the treatment of myogenic originated temporomandibular disorders (TMD).

BACKGROUND DATA

Limited studies have demonstrated that LLLT may have a therapeutic effect on the treatment of TMD.

METHODS

Thirty-nine patients with myogenic TMD-associated orofacial pain, limited mandibular movements, chewing difficulties, and tender points were included in this study. Twenty-four of them were treated with LLLT for 10 sessions per day excluding weekends as test group, and 15 patients with the same protocol received placebo laser treatment as a control group. These parameters were assessed just before, just after, and 1 month after the treatment.

RESULTS

Maximal mouth-opening improvement, and reductions in pain and chewing difficulty were statistically significant in the test group when compared with the control group. Statistically significant improvements were also detected between two groups regarding reduction in the number of tender points.

CONCLUSION

Based on the results of this placebo-controlled report, LLLT is an appropriate treatment for TMD and should be considered as an alternative to other methods.

Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I diagnoses in an Italian patient population

The aim of this work was twofold: to evaluate the prevalence of different Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis in an Italian population of subjects seeking TMD treatment in a tertiary clinic; and to compare data with those from similar studies in the literature. Participants in this study were 433 consecutive patients seeking TMD treatment at the Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy; mean age of patients was 38.8 years, with a female:male ratio of 2.6:1 (276 females, 73.2%; 101 males, 26.8%). RDC/TMD guidelines for examination were adopted to assign axis I diagnosis. The prevalence of RDC/TMD diagnoses was 38.2% (144/377) for group I disorders (muscle disorders), 52.3% (197/377) for group II disorders (disc displacements), and 52.6% (198/377) for group III disorders (arthralgia, osteoarthritis, osteoarthrosis). The present investigation provided findings that, compared and integrated with literature data, can be useful to create a world-wide database, in accordance with the nature of the RDC/TMD classification system.

Depression, pain, and somatoform disorders

PURPOSE OF REVIEW

The frequent co-occurrence of depression and somatic symptoms poses a continuing challenge to clinicians, researchers and experts involved in drawing up classifications. In this review we present recently published literature on aspects of epidemiology, classification and treatment in this important overlap area.

RECENT FINDINGS

From the multitude of papers published annually on the co-occurrence of different pain conditions and depression, temporomandibular dysfunction stands out this year by sheer quantity; it can be seen as a model case of the necessity for differentiated high-quality assessments on the biological as well as the psychosocial level. There is a general move to separate utility of diagnostic classifications from their validity, and this strengthens classificatory approaches that help to view the regular overlap of depression, pain and other somatic symptoms as the rule rather than the exception. The incorporation of cognitive variables like causal attributions should help to distinguish clinically relevant subtypes among overlap cases. The classificatory future of the category of 'somatoform disorders' is somewhat in doubt, but reforms seem to be more productive than abolishment. Psychopharmacology provides rather intense recent coverage of the overlap field, with newer dual serotonergic-noradrenergic reuptake inhibitors offering some promise.

SUMMARY

Treating the overlap of depression, pain and other somatic symptoms as the rule rather than the exception is necessary for adequate aetiological research as well as for diagnosis and treatment, with one-dimensional classificatory and treatment approaches almost certainly being insufficient.