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Fang ZY, Yang Y, Yao Y, Liu SS, Liu LK, Lu SJ, Zeng H, Cai B, Xu LL. Oral behaviors and anxiety are significant predictors of jaw function limitation in patients with anterior disc displacement without reduction. Arch Oral Biol 2024; 166:106033. [PMID: 38986191 DOI: 10.1016/j.archoralbio.2024.106033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/23/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE We aimed to describe jaw function characteristics in patients with anterior disc displacement without reduction (ADDWoR) using the jaw function limitation scale (JFLS), and to investigate the effects of biopsychosocial risk factors on limited jaw function. DESIGN In this cross-sectional study of 636 patients with ADDWoR (females, 568; males, 68), we used the JFLS to assess jaw function. Behavioral, psychological, sociodemographic, and biomedical data were collected. Multivariate logistic regression analysis was used to determine risk factors affecting limited jaw function. A receiver operating characteristic curve was used to evaluate the predictive effect of these risk factors. RESULTS ADDWoR-associated limitations included restricted jaw mobility and mastication, which exceeded median global functional limitations scale scores, especially mouth opening to bite an apple and chewing tough food. Females had greater limitations in jaw mobility, verbal and emotional communication, and overall. Multivariate logistic regression analysis findings indicated that oral behaviors, anxiety, sex, pain intensity, and maximal mouth opening (MMO) were predictive of limited jaw function (area under the curve, 72 %). CONCLUSION Patients with ADDWoR reported mastication and jaw mobility restrictions, with females having more pronounced limitations, and specific risk factors identified as significant predictors of jaw function limitations. Along with pain relief and improvement in MMO, appropriate psychological counseling and oral behavioral correction facilitates recovery of jaw function in such patients.
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Affiliation(s)
- Zhong-Yi Fang
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Yang Yang
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Yuan Yao
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Sha-Sha Liu
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Li-Kun Liu
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Shen-Ji Lu
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Hong Zeng
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Bin Cai
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Li-Li Xu
- Department of Rehabilitation Medicine, The Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China.
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Rogowsky L, Illmann CF, Macadam SA, Lennox PA, Van Laeken N, Bovill ES, Doherty C, Isaac KV. Prevalence and Severity of Chronic Pain in Patients Receiving Mastectomy with Alloplastic Immediate Breast Reconstruction: A Survey Study. Plast Surg (Oakv) 2024; 32:415-422. [PMID: 39104921 PMCID: PMC11298134 DOI: 10.1177/22925503221128985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
Introduction: Breast cancer is the most frequently diagnosed cancer worldwide. For those undergoing mastectomy, the choice of alloplastic immediate breast reconstruction (IBR) is increasingly favored. Post-operative chronic pain is an important consideration in this decision, but there is a paucity of data for those undergoing alloplastic IBR. We sought to examine the prevalence, severity, and risk factors for the development of chronic pain in this cohort using validated patient-reported outcome measures. Methods: A cross-sectional survey study was conducted among patients receiving mastectomy with alloplastic IBR. Participants completed 3 surveys querying chronic pain, specifically the Breast Cancer Pain Questionnaire (BCPQ), Brief Pain Inventory (BPI), and BREAST-Q. Participant medical records were reviewed for demographic and surgical variables. Results: A total of 118 patients participated in the study-a response rate of 33.6%. Chronic pain prevalence was high (52.5%), and only 29.0% of these patients had consulted a physician regarding their pain. Among those reporting chronic pain (n = 62), the median severity of pain was 3.1 on an 11-point scale. Chronic pain was associated with radiation (p = .018), bilateral reconstruction (p = .05), worse emotional health (p = .0003), less self (p = .022), and sexual confidence (p = .044). Inter-tool reliability was high, with no significant difference in responses between the 3 surveys. Conclusion: In this cohort, chronic pain is supported as a significant concern among patients who have undergone mastectomy with alloplastic IBR. Given the burden of chronic pain, there is an opportunity to intervene with preventative measures and support for its management.
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Affiliation(s)
- Larissa Rogowsky
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline F. Illmann
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheina A. Macadam
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter A. Lennox
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Van Laeken
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esta S. Bovill
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn V. Isaac
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Larkin N, Fricton V, Sangalli L, Prodoehl J, Fricton J. Prevalence and impact of signs and symptoms of temporomandibular disorders in dental students and faculty. J Dent Educ 2024. [PMID: 39086000 DOI: 10.1002/jdd.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/22/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Temporomandibular disorders (TMD) affect individuals undergoing increased stress, for example, dental professionals. No study to date has compared dental students and faculty in TMD manifestation. This cross-sectional study compared prevalence, risk factors, and impact on daily activities of self-reported TMD signs/symptoms between dental students and faculty at a predoctoral dental school, and between preclinical (first- to second-year) and clinical (third- to fourth-year) students. METHODS A REDCap survey was sent to dental students and faculty, assessing TMD signs/symptoms (TMD Symptom Questionnaire), pain intensity (Chronic Graded Pain Scale), jaw function (Jaw Function Limitation Scale), parafunctions (Oral Behavioral Checklist), previous TMD treatments, anxiety/depression symptoms (Patient Health Questionnaire), perceived stress (Perceived Stress Scale), and sleep quality (RU-SATED Scale). Outcomes were compared between groups using chi-square and t-tests, adjusting for covariates with analyses of covariance (ANCOVA). RESULTS Data derived from N = 145 participants (N = 108 students, N = 37 faculty). Dental students reported significantly higher prevalence (90.1% vs. 75.7%, p = 0.020) and greater number of TMD signs/symptoms (5.3 ± 3.5 vs. 3.0 ± 2.7, p < 0.001) compared to faculty. Students reported significantly more parafunctional activities (p = 0.000), jaw-strain episodes (prolonged mouth opening, p = 0.007), higher stress level (p = 0.008), and lower sleep quality (p = 0.002) than faculty. Difference in number of TMD signs/symptoms was maintained after adjusting for stress, sleep quality, and parafunctional/jaw-strain activities. Clinical students utilized significantly more often evidence-based TMD treatment compared to preclinical students. CONCLUSIONS High prevalence of self-reported TMD was observed among dental students and faculty, with students reporting higher prevalence and impairment despite working in the same environment. Findings underscore the importance of education on preventive measures early in dental training to address contributing factors and TMD management.
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Affiliation(s)
- Nathan Larkin
- College of Dental Medicine - Illinois, Midwestern University, Downers Grove, Illinois, USA
| | - Vincent Fricton
- College of Dental Medicine - Illinois, Midwestern University, Downers Grove, Illinois, USA
| | - Linda Sangalli
- College of Dental Medicine - Illinois, Midwestern University, Downers Grove, Illinois, USA
| | - Janey Prodoehl
- College of Dental Medicine - Illinois, Midwestern University, Downers Grove, Illinois, USA
- Physical Therapy Program, Midwestern University, Downers Grove, Illinois, USA
| | - James Fricton
- Division of TMD and Orofacial Pain, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
- Minnesota Head and Neck Pain Clinic, Plymouth, Minnesota, USA
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Vallin S, Liv P, Häggman-Henrikson B, Visscher CM, Lobbezoo F, Lövgren A. Temporomandibular disorder pain is associated with increased sick leave and reduced health related quality of life. Eur J Pain 2024. [PMID: 39072933 DOI: 10.1002/ejp.2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are the most common reason for chronic pain in the orofacial area and significantly impact the lives of those affected. The role of lifestyle factors in TMD, however, remains less explored. This cohort study aims to estimate TMD prevalence by addressing potential selection biases and to evaluate the association between TMD and lifestyle factors with a specific focus on sick leave and health related quality of life. METHODS By linking data on TMD in the general population in Västerbotten, northern Sweden (n = 180,000) to health survey data (n = 120,000), information on sociodemographic factors and quality of life was available for 52,961 individuals (50.6% women) with a mean age of 53 years. We applied inverse probability weighting to adjust for selection bias and Poisson regression to explore associations with TMD. RESULTS TMD prevalence was 9.2% during the study period, being higher in women (12.9%) than men (5.4%). Weighting for varying visiting frequencies did not affect TMD prevalence (average difference 0.4% points). Individuals with TMD, especially women, reported more sick leave and use of pain medication, with a significant association between TMD and increased sick leave (prevalence ratio 1.89, 95% CI: 1.78-2.01) among both women and men. In addition, TMD was associated with a lower health related quality of life (p < 0.001). CONCLUSION The association of TMD with sick leave highlights the condition's profound impact on the lives of affected individuals. These findings underscore the influence of TMD on work life and the burden of TMD on the societal level. SIGNIFICANCE STATEMENT The findings provide insight into how TMD affect individuals, by incorporating lifestyle factors, social determinants and the impact of sick leave at a population level. By incorporating these areas into the study of TMD, we can deepen our understanding of how TMD affects individuals' lives. This approach may also create opportunities to develop more comprehensive strategies to address TMD, focusing on broader implications beyond the clinical symptoms.
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Affiliation(s)
- S Vallin
- Department of Odontology, Orofacial Pain and Jaw Function, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - P Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - B Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - C M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Lövgren
- Department of Odontology, Orofacial Pain and Jaw Function, Faculty of Medicine, Umeå University, Umeå, Sweden
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Yakkaphan P, Lambru G, Renton T. Impact of migraine and fibromyalgia on temporomandibular disorder: A retrospective study on pain, psychological factors and quality of life. J Oral Rehabil 2024. [PMID: 38965737 DOI: 10.1111/joor.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 05/18/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study assessed the impact of migraine and fibromyalgia (FM) in TMD patients, focusing on pain, anxiety, depression, and quality of life (QoL). Additionally, we investigated how these variables relate to the total number of comorbidities to gain insights into their interactions. METHODS A retrospective data collection was conducted during January 2016 to December 2022, involving 409 adult TMD patients. TMD patients were categorised into four groups: those without comorbidity (TMD-only) and those with comorbid migraine and/or fibromyalgia (TMD + MG, TMD + FM and TMD + MG + FM). Quantitative variables were compared among them. Linear regression was used to analyse the associations between these variables. RESULTS Most of study population were women (79%) with a mean age of 44.43 years. TMD + MG patients reported longer pain duration, higher pain scores and greater pain interference compared with TMD-only patients. Similarly, TMD + FM patients had higher pain intensity than patients with TMD only. Both the TMD + MG and TMD + FM groups had higher levels of anxiety, depression, and health impairment compared with patients with TMD only. Patients with all three pain conditions (TMD + MG + FM) experienced the longest pain duration, highest pain intensity, psychological distress, and impaired QoL. The result showed positive associations between pain outcomes, psychological measures, pain's impact on QoL, and the number of comorbidities and a negative association between overall health states and the number of comorbidities. CONCLUSIONS These findings underscore the importance of considering the presence of comorbidities and addressing physical and psychological aspects in the management of TMD patients.
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Affiliation(s)
- Pankaew Yakkaphan
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK
- Faculty of Dentistry, Prince of Songkla University, Songkhla, Thailand
| | - Giorgio Lambru
- The Headache and Facial Pain Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tara Renton
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK
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Yap AU, Sultana R, Natu VP. Somatic and temporomandibular disorder symptoms - Idioms of psychological distress in Southeast Asian youths. Cranio 2024; 42:364-371. [PMID: 34569454 DOI: 10.1080/08869634.2021.1982496] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital, Jurong East, Singapore, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Dental Research Institute, National Dental Centre Singapore, Singapore
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore, Singapore
| | | | - Vaishali Prakash Natu
- Faculty of Dentistry, National University of Singapore, Singapore
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore, Singapore
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Izzetti R, Carli E, Gennai S, Giuca MR, Graziani F, Nisi M. Treatment Outcomes in Patients with Muscular Temporomandibular Joint Disorders: A Prospective Case-Control Study. Dent J (Basel) 2024; 12:129. [PMID: 38786527 PMCID: PMC11119471 DOI: 10.3390/dj12050129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/29/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Muscular temporomandibular joint disorders (M-TMDs) encompass a wide range of painful muscular conditions, which can provoke functional limitation and severely affect quality of life. The aim of the present study was to assess the treatment outcomes in patients affected by M-TMDs in terms of pain scores assessed with pressure pain threshold (PPT). The levels of depression, anxiety, and the Oral Health Impact Profile were also assessed and compared to healthy controls. Patients with a clinical diagnosis of M-TMDs and a control group of healthy subjects were enrolled. At baseline, OHIP-14, PHQ-9, and GAD-7 were administered. PPT was registered at the level of masseter and temporalis muscles. The patients affected by M-TMDs were then treated with oral splints and physio-kinesiotherapy following a standardized treatment protocol. At the 6-month follow-up of M-TMD-affected patients, PPT was registered, and the questionnaires were re-administered to evaluate treatment outcomes. In total, sixty patients and sixty controls were enrolled. The treatment of M-TMDs produced a significant improvement in PPT at the level of the masseter muscle. OHIP-14 at baseline in the M-TMD group was significantly higher compared to the control group (p < 0.05). At the 6-month follow-up, a significant reduction in OHIP-14 scores was registered, although with higher scores compared to the control group (p < 0.05). PHQ-9 was significantly higher at baseline in the M-TMD group (p < 0.05) and decreased to values comparable to the control group after treatment. GAD-7 presented statistically significant differences between the control group and M-TMD patients at baseline (p < 0.05) and between pre- and post-treatment in the M-TMD group. Following treatment, the GAD-7 scores were comparable to the control group. The symptom burden associated with M-TMDs negatively affects quality of life, with higher oral health impairment and a tendency towards depression and anxiety compared to healthy subjects. Following treatment, an improvement in both PPT and quality of life was observed.
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Affiliation(s)
- Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, 56126 Pisa, Italy
| | - Elisabetta Carli
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, 56126 Pisa, Italy
| | - Maria Rita Giuca
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, 56126 Pisa, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, 56126 Pisa, Italy
| | - Marco Nisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, 56126 Pisa, Italy
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Salbego RS, Conti PCR, Soares FFC, Ferreira DMAO, Herreira-Ferreira M, de Lima-Netto BA, Svensson P, Costa YM, Bonjardim LR. Influence of psychometric and sleep quality features on painful mechanical sensitivity and pain modulation in patients with temporomandibular disorders. Clin Oral Investig 2024; 28:302. [PMID: 38714576 DOI: 10.1007/s00784-024-05699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/28/2024] [Indexed: 05/10/2024]
Abstract
Investigating the collective impact of psychometric properties and sleep quality on pain sensitivity in temporomandibular disorder (TMD) patients could improve clinical management strategies. OBJECTIVE Assessing whether combined psychometric properties and sleep quality impact painful mechanical sensitivity and pain modulation in TMD patients. MATERIALS AND METHODS A cross-sectional study using secondary data analysis of 77 TMD patients and 101 controls. All participants completed questionnaires characterizing their psychometric profile (anxiety, depression, stress and catastrophizing) and sleep quality, alongside psychophysical tests for painful mechanical sensory (mechanical pain threshold (MPT), pressure pain threshold (PPT), and wind-up ratio (WUR)) and conditioned pain modulation (CPM). Participants were grouped into "High distress" or "Low distress" categories based on psychometric properties and sleep quality using hierarchical cluster and k-means analyses. Multiple linear regression evaluated the influence of TMD, age, and the distress cluster on MPT, WUR, PPT, and CPM in masseter and thenar muscles. Differences were statistically significant when p < 0.05. RESULTS The presence of TMD was the strongest predictor of mechanical painful sensitivity in the trigeminal region (MPT[F(3,174) = 51.902;p < .001;R2 = .463]; TMD presence (β = -.682) / PPT[F(3,174) = 15.573;p < .001;R2 = .198] TMD presence (β = -.452), and extra-trigeminal (MPT[F(3,174) = 35.897;p < .001;R2 = .382] TMD (β = -.647) / CPM [F(3,174) = 4.106;p < .05;R2 = .050] TMD presence (β = .197). Furthermore, neither the high distress group nor the low distress group were able to significantly influence the variation of the values of any of the psychophysical variables evaluated (p > .05). CONCLUSIONS There is not a significant influence of impairment clusters based on psychological variables and sleep quality on painful mechanical sensitivity and pain modulation, regardless of the presence of TMD. CLINICAL RELEVANCE This outcome suggests that psychosocial factors and sleep quality may not play a decisive role in the sensory-discriminative aspect of pain, particularly concerning painful TMD.
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Affiliation(s)
- Rafaela Stocker Salbego
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
| | - Paulo César Rodrigues Conti
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Matheus Herreira-Ferreira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Yuri Martins Costa
- Department of Biosciences, Piracicaba School of Dentistry, University of Campinas, Piracicaba, Brazil
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Taimeh D, Riordain RN, Fedele S, Leeson R. Validity and internal consistency of four scales in patients with TMD: PHQ8, GAD7, PHQ15 and JFLS20. Oral Dis 2024; 30:2473-2484. [PMID: 37798933 DOI: 10.1111/odi.14729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/18/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES The aim of this cross-sectional study was to explore the structural validity and internal consistency reliability of General Anxiety Disorder-7, Patient Health Questionnaire-8, 15 and Jaw Functional Limitation Scale-20 in patients with chronic pain of temporomandibular disorders. MATERIALS AND METHODS Validity and reliability were assessed in 129 patients diagnosed according to the diagnostic criteria for temporomandibular disorders. Structural validity was explored using factor analysis, and internal consistency by calculating Cronbach α. RESULTS Confirmatory factor analysis revealed a suitable 2-factor model for Patient Health Questionnaire-8, with Cronbach α of 0.89, and 0.86. One and 2-factor models were suitable for General Anxiety Disorder-7, with overall Cronbach α of 0.93 for the 1-factor model, and 0.91 and 0.84 for both factors in a 2-factor model. A 4-factor solution was appropriate for Patient Health Questionnaire-15, with Cronbach α of 0.72, 0.57, 0.71 and 0.73 for each factor separately. Exploratory factor analysis was conducted to explore the factor structure of Jaw Functional Limitation Scale 20, and a 3-factor solution was appropriate. CONCLUSIONS This study provides positive evidence of structural validity and internal consistency of these questionnaires in patients with pain of temporomandibular disorders. However, additional testing is required to explore further psychometric properties.
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Affiliation(s)
- Dina Taimeh
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, University of Jordan, Amman, Jordan
| | - Richeal Ni Riordain
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Cork University Dental School and Hospital, Cork, Ireland
| | - Stefano Fedele
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Rachel Leeson
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
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10
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Marpaung C, Yap AU, Hanin I, Fitryanur A. Psychological distress and well-being: their association with temporomandibular disorder symptoms. Cranio 2024; 42:285-291. [PMID: 34432614 DOI: 10.1080/08869634.2021.1971449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study investigated the associations between temporomandibular disorder (TMD) symptoms, psychological distress, and well-being. METHODS A total of 372 university students were recruited and stratified into no TMD, TMD pain, TMJ sounds, and combined TMD groups. Psychological distress and well-being were assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Scales of Psychological Well-being-18 (SPWB-18), respectively. Data were appraised with Kruskal-Wallis/Mann-Whitney U tests and logistic regression analysis (α = 0.05). RESULTS Significant differences in anxiety, stress, and autonomy scores were observed among the four groups, and psychological distress was mostly negatively correlated to psychological well-being. Multivariate analyses revealed that anxiety was associated with TMD pain, TMJ sounds, and combined TMD, while autonomy was related to TMJ sounds. CONCLUSION Participants with TMD symptoms generally experienced more psychological distress and lower autonomy. Anxiety appeared to increase the likelihood of TMD pain and/or TMJ sounds.
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Affiliation(s)
- Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
| | - Adrian Ujin Yap
- Department of Prosthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, SingHealth, Singapore, Singapore
| | - Isya Hanin
- Department of Prosthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
| | - Astrya Fitryanur
- Department of Prosthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
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11
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Zlendić M, Vrbanović E, Tomljanović M, Gall Trošelj K, Đerfi KV, Alajbeg IZ. Association of oral behaviours and psychological factors with selected genotypes in pain-related TMD. Oral Dis 2024; 30:1702-1715. [PMID: 37036392 DOI: 10.1111/odi.14583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To investigate frequency of single nucleotide polymorphisms (SNPs) in pain-related temporomandibular disorders (TMDp) and to determine whether specific SNPs, psychological, psychosomatic and behavioural characteristics are predictive for pain existence and intensity (low pain intensity (LPI)/high pain intensity (HPI)). METHODS Genomic DNA was extracted from buccal mucosa swabs (85 TMDp;85 controls) for evaluating frequency of selected SNPs: catechol-O-methyltransferase (rs4680, rs4818), opiorphin (rs1387964), alpha subunit of voltage-gated sodium channel Nav1.1 (rs6432860) and voltage-gated sodium channel Nav1.9 (rs33985936). Participants completed questionnaires on somatosensory amplification, anxiety and depression symptoms and oral behaviours (OB). RESULTS Sleep-related OB frequency was higher in TMDp patients compared to controls (p = 0.008). Compared to LPI, HPI patients had higher depression (p = 0.020) and anxiety scores (p = 0.017). TMDp group showed higher frequency of CC genotype (rs1387964) than controls (12.9% vs. 3.5%, p = 0.025). Following adjustments for age, sex and sleep-related OB, the significance of the recessive model (CC vs. TC + TT) between TMDp patients and controls was retained (OR = 5.783; 95%CI: 1.454-23.004). Frequency of GG genotype (rs4680 and rs4818) was higher in HPI compared to LPI patients (40% vs. 11.4%, p = 0.006; 24% vs. 3%; p = 0.012, respectively). The difference remained significant after adjusting for age, sex, depression, anxiety and sleep-related OB (rs4680: OR = 3.621; 95%CI: 1.580-8.297; rs4818: OR = 4.919, 95%CI: 1.641-14.746). CONCLUSION This study has demonstrated that rs1387964 CC genotype was associated with TMDp while rs4680 GG and rs4818 GG genotypes contributed to HPI.
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Affiliation(s)
- Marko Zlendić
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ema Vrbanović
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Tomljanović
- Laboratory for Epigenomics, Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Koraljka Gall Trošelj
- Laboratory for Epigenomics, Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Kristina Vuković Đerfi
- Laboratory for Personalized Medicine, Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Iva Z Alajbeg
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
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12
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Yao Y, Liu SS, Jin L, Zeng H, Jiang X, Fang ZY, Cai B, Xu L. Mental health and jaw function of patients with anterior disc displacement with reduction. J Oral Rehabil 2024; 51:677-683. [PMID: 38087998 DOI: 10.1111/joor.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/08/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND The mental health of patients with temporomandibular disorder or other jaw dysfunction is a primary concern in clinical practice, but the extent of these symptoms in this patient subset is not yet well understood. OBJECTIVES This cross-sectional study aimed to compare the mental health and jaw function between patients with anterior disc displacement with reduction (ADDWR) and healthy individuals. METHODS In total, 170 patients with ADDWR and 163 healthy participants enrolled in this study from March 2020 to December 2021. All participants completed a single assessment, including a pain rating and several questionnaires to assess jaw dysfunction, depression, and anxiety. All scores and the grade distribution of somatization, depression and anxiety were analysed between groups. RESULTS Significant differences were found in measures of pain, jaw function and somatization; the ADDWR group had significantly higher pain and functional jaw limitations than the healthy group. The grade distribution of somatic symptoms also differed between groups: the distribution of patients who reported mild and above scores in the ADDWR group was significantly higher than that of the healthy group. Depression and anxiety scores or grade distributions were not significantly different by group. CONCLUSION The jaw function of patients seeking treatment for ADDWR was lower than that of non-TMD individuals. They did not show high anxiety and depression symptoms, but their somatic symptoms were more apparent.
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Affiliation(s)
- Yuan Yao
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sha Sha Liu
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Jin
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Zeng
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Jiang
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong Yi Fang
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Xu
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Bouloux GF, Chou J, DiFabio V, Ness G, Perez D, Mercuri L, Chung W, Klasser GD, Bender SD, Kraus S, Crago CA. Guidelines for the Management of Patients With Orofacial Pain and Temporomandibular Disorders. J Oral Maxillofac Surg 2024:S0278-2391(24)00200-3. [PMID: 38643965 DOI: 10.1016/j.joms.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Gary F Bouloux
- Family Professor, Division Chief, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Joli Chou
- Associate Professor, Department Of Oral and Maxillofacial Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vince DiFabio
- Associate Clinical Professor, Oral and Maxillofacial Surgery, University of Maryland School of Dentistry, University of Maryland Medical Center, Baltimore, MD
| | - Greg Ness
- Emeritus Professor-Clinical, The Ohio State University, Private Practice, Oral and Facial Surgery for Adults and Children, Columbus, OH
| | - Daniel Perez
- Associate Professor and Program Director, Oral and Maxillofacial Surgery, University Texas Health Sciences San Antonio, San Antonio, TX
| | - Louis Mercuri
- Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, Chicago, IL
| | - William Chung
- Clinical Professor, Residency Program Director, Indiana University School of Dentistry and Hospital Medicine, Indianapolis, IN
| | - Gary D Klasser
- Certificate Orofacial Pain, Professor, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA
| | - Steven D Bender
- Clinical Associate Professor, Director, Clinical Center for Facial Pain and Sleep Medicine, Department of Oral and Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, TX
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Sun R, Zhang S, Si J, Zhang L, Yang H, Ye Z, Xiong X. Association Between Oral Behaviors and Painful Temporomandibular Disorders: A Cross-Sectional Study in the General Population. J Pain Res 2024; 17:431-439. [PMID: 38328021 PMCID: PMC10848921 DOI: 10.2147/jpr.s449377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background Studies have reported correlations between various oral behaviors and painful temporomandibular disorders (TMD), yet comprehensive research on the independent effects of each oral behavior within the general population remains sparse. Objective This cross-sectional study aimed to investigate the association between painful TMD (PT) and various oral behaviors in general population. Methods A questionnaire survey was conducted with participants to collect data encompassing demographic characteristics, eight specific oral behaviors, and the 5 major TMD symptoms(5Ts) checklist. Participants were categorized into PT and non-PT (NPT) groups based on their responses to the 5Ts checklist. Those reporting TMJ/facial pain or headaches were assigned to the PT group, while all other participants constituted the NPT group. Both univariate and multivariate logistic regression analyses were employed to evaluate the association between individual oral behavior and the presence of PT, controlling for demographic confounders including age, sex, systemic diseases, and dental treatments history. Results A total of 441 valid questionnaires were received, including 156 males and 285 females. The prevalence of PT was identified to be 33.33%, with 61.00% of participants engaging in one or more types of oral behaviors. Each oral behavior was more frequently reported in the PT group compared to the NPT group. The univariate logistic regression analysis identified positive correlations between all eight oral behaviors and PT. In the multivariate logistic regression analysis, these associations persisted after adjustment for demographic confounders including age, sex, history of systemic diseases and dental treatments (P<0.01). The behaviors most strongly associated with PT were "Hold or jut jaw forward/to the side" (OR:4.478), "Hold, tighten or tense muscles without clench" (OR:3.343) and "Hold jaw in rigid or tense position" (OR:3.209). Conclusion The presence of oral behaviors has significant association with PT. Individuals exhibiting multiple oral behaviors are more likely to experience PT. Additional studies are needed to clarify the effects of reducing oral behaviors on pain-related symptoms.
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Affiliation(s)
- Ruonan Sun
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Shuyuan Zhang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jiarui Si
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Liming Zhang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Haolun Yang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zheng Ye
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xin Xiong
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Murray GM, Sessle BJ. Pain-sensorimotor interactions: New perspectives and a new model. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 15:100150. [PMID: 38327725 PMCID: PMC10847382 DOI: 10.1016/j.ynpai.2024.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/25/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
How pain and sensorimotor behavior interact has been the subject of research and debate for many decades. This article reviews theories bearing on pain-sensorimotor interactions and considers their strengths and limitations in the light of findings from experimental and clinical studies of pain-sensorimotor interactions in the spinal and craniofacial sensorimotor systems. A strength of recent theories is that they have incorporated concepts and features missing from earlier theories to account for the role of the sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions of pain in pain-sensorimotor interactions. Findings acquired since the formulation of these recent theories indicate that additional features need to be considered to provide a more comprehensive conceptualization of pain-sensorimotor interactions. These features include biopsychosocial influences that range from biological factors such as genetics and epigenetics to psychological factors and social factors encompassing environmental and cultural influences. Also needing consideration is a mechanistic framework that includes other biological factors reflecting nociceptive processes and glioplastic and neuroplastic changes in sensorimotor and related brain and spinal cord circuits in acute or chronic pain conditions. The literature reviewed and the limitations of previous theories bearing on pain-sensorimotor interactions have led us to provide new perspectives on these interactions, and this has prompted our development of a new concept, the Theory of Pain-Sensorimotor Interactions (TOPSMI) that we suggest gives a more comprehensive framework to consider the interactions and their complexity. This theory states that pain is associated with plastic changes in the central nervous system (CNS) that lead to an activation pattern of motor units that contributes to the individual's adaptive sensorimotor behavior. This activation pattern takes account of the biological, psychological, and social influences on the musculoskeletal tissues involved in sensorimotor behavior and on the plastic changes and the experience of pain in that individual. The pattern is normally optimized in terms of biomechanical advantage and metabolic cost related to the features of the individual's musculoskeletal tissues and aims to minimize pain and any associated sensorimotor changes, and thereby maintain homeostasis. However, adverse biopsychosocial factors and their interactions may result in plastic CNS changes leading to less optimal, even maladaptive, sensorimotor changes producing motor unit activation patterns associated with the development of further pain. This more comprehensive theory points towards customized treatment strategies, in line with the management approaches to pain proposed in the biopsychosocial model of pain.
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Affiliation(s)
- Greg M. Murray
- Discipline of Restorative and Reconstructive Dentistry, Sydney School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Darcy Road, Westmead, NSW 2145, Australia
| | - Barry J. Sessle
- Faculty of Dentistry and Temerty Faculty of Medicine Department of Physiology, and Centre for the Study of Pain, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada
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Riley JLI, Rindal DB, Velly AM, Anderson GC, Johnson KS, Gilbert GH, Schiffman EL. Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN. J Oral Facial Pain Headache 2023; 37:195-206. [PMID: 37975783 PMCID: PMC10664701 DOI: 10.11607/ofph.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/16/2023] [Indexed: 11/19/2023]
Abstract
AIMS To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. METHODS This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. RESULTS Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. CONCLUSIONS Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.
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Temporomandibular Joint Surgery. J Oral Maxillofac Surg 2023; 81:E195-E220. [PMID: 37833023 DOI: 10.1016/j.joms.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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18
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Porporatti AL, Schroder ÂGD, Lebel A, Moreau N, Misery L, Alajbeg I, Braud A, Boucher Y. Is burning mouth syndrome associated with stress? A meta-analysis. J Oral Rehabil 2023; 50:1279-1315. [PMID: 37332081 DOI: 10.1111/joor.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/04/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Some studies have shown burning mouth syndrome (BMS) as comorbid psychosocial and psychiatric disorders, and as well, pointed at stress as a major risk factor. OBJECTIVE The aim of this meta-analysis was to answer the following question: 'Is there an association between BMS and stress, compared to healthy controls?' METHODS Two reviewers searched for the effect of stress in BMS and published on five main databases and three from the grey literature. Various questionnaires and biomarkers were analysed. Of the 2489 selected articles, 30 met the inclusion criteria. Studies englobed questionnaires, such as Perceived Stress Questionnaire, Lipp Stress Symptoms Inventory, Holmes-Rahe scale, Depression, Anxiety, and Stress Scale (DASS-21), Recent Experience Test; and various biomarkers, such as cortisol, opiorphin, IgA, α-amylase and interleukins. RESULTS In all studies with questionnaires, stress was significantly increased in the BMS group vs. control. Patients with BMS presented 25.73% higher cortisol levels, 28.17% higher IgA levels and 40.62% higher α-amylase levels than controls. Meta-analysis found that BMS subjects presented 3.01 nmoL/L [0.53; 5.50] higher cortisol levels, 84.35 kU/L [15.00; 153.71] higher α-amylase levels, 29.25 mg/mL [9.86; 48.64] higher IgA levels and 258.59 pg/mL [59.24; 457.94] higher IL-8 levels than control. No differences were found for opiorphin concentration in ng/mL [-0.96; 2.53]. For interleukins, no differences were founded for IL-1 β, IL-2, IL-4, IL-6, IL-8, IL-10 and TNF-α. CONCLUSION Based on the available evidence, this meta-analysis suggests more stress factors in questionnaire-based studies, and higher levels of cortisol, α-amylase, IgA and IL-8 biomarkers in BMS subjects than controls.
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Affiliation(s)
- André Luís Porporatti
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Ashley Lebel
- Laboratoire de Neurobiologie OroFaciale, Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nathan Moreau
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité and Hôpital Bretonneau (AP-HP), Paris, France
| | | | | | - Adeline Braud
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
| | - Yves Boucher
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
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Santana-Penín U, Santana-Mora U, López-Solache A, Mora MJ, Collier T, Pocock SJ, Lorenzo-Franco F, Varela-Centelles P, López-Cedrún JL. Remodeling dental anatomy vs sham therapy for chronic temporomandibular disorders. A placebo-controlled randomized clinical trial. Ann Anat 2023; 250:152117. [PMID: 37302432 DOI: 10.1016/j.aanat.2023.152117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence regarding the etiology or effective treatments for chronic orofacial pain, the majority diagnosed as temporomandibular disorder (TMD), is limited. PURPOSE To investigate whether occlusal equilibration therapy (ET) and decreasing the (higher) angle of the lateral guidance on the nonworking-side leads to a reduction in chronic TMDs intensity. METHODS It was conducted a randomized, explanatory, single blind with blinded assessment, placebo-controlled trial with strong protection against bias involving patients with chronic TMDs. Participants were randomly assigned to receive equilibration therapy or sham therapy. ET in this study consisted of minimal invasive occlusal remodeling to obtain balanced occlusion with reduction of the steeper angle of lateral mandibular movement with respect to the Frankfort plane. The primary outcome was a change in the pain intensity score (on a 0-10 point scale, with 0 indicating no pain and 10 the worst possible pain) at month 6. Secondary outcomes include maximum unassisted mouth opening and psychological distress. RESULTS A total of 77 participants underwent randomization, 39 of whom received ET and 38 sham therapy. The trial was stopped early for efficacy, according to preestablished rules when 67 participants (n = 34, n = 33, respectively) had completed the analysis. At month 6, the mean unadjusted pain intensity score was 2.1 in the ET and 3.6 in the sham therapy group (adjusted mean difference, -1.54; 95% confidence interval [CI] -0.5 to -2.6; P = 0.004; ANCOVA model). The mean increase in maximum unassisted mouth opening (main secondary outcome) was significantly higher in the real therapy group (adjusted mean difference 3.1 mm, 95% CI 0.5-5.7, p = 0.02). CONCLUSION ET significantly reduced the intensity of facial pain associated with chronic TMDs and increased maximum unassisted mouth opening, as compared with sham therapy, over the course of 6 months. There were no serious adverse events. Funded by the Instituto de Salud Carlos III from the Ministry of Science and Innovation of the Government of Spain and European Regional Development Fund, Grant nº PI11/02507; "una manera de hacer Europa".
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Affiliation(s)
- Urbano Santana-Penín
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Urbano Santana-Mora
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Alicia López-Solache
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - María Jesús Mora
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Pablo Varela-Centelles
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José Luís López-Cedrún
- Oral and Maxillofacial Surgery Service, University Hospital of A Coruña, A Coruña, Spain
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Yap AU, Lee DZR. Painful temporomandibular disorders in Confucian-heritage cultures: Their inter-relationship with bodily pain, psychological well-being and distress. J Oral Rehabil 2023; 50:948-957. [PMID: 37246585 DOI: 10.1111/joor.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/10/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are common and affect individuals negatively. OBJECTIVES This study investigated the inter-relationship of painful TMDs with bodily pain, psychological well-being and distress in young people from a Confucian-heritage culture (CHC). METHODS Adolescents/young adults were recruited from a polytechnic in Singapore. While the presence/severity of painful TMDs and bodily pain were established with the DC/TMD Pain Screener (TPS) and Maciel's Pain Inventory, psychological well-being and distress were evaluated with the Scales of Psychological Well-being-18 (SPWB-18) and Patient Health Questionnaire-4 (PHQ-4). Statistical explorations were conducted using chi-square/Mann-Whitney U tests, Spearman's correlation and logistic regression analyses (α = .05). RESULTS Among the 225 participants (mean age 20.1 ± 3.9 years) examined, 11.6% had painful TMDs and 68.9% experienced multisite bodily pain. Though painful TMDs were accompanied by a higher occurrence of multisite bodily pain, the overall/discrete number of bodily pain sites did not differ substantially between the 'no TMD pain' (NT) and 'with TMD pain' (WT) groups. Besides ear pain, differences in overall/discrete bodily pain scores were also insignificant. However, significant differences in environmental mastery, overall psychological distress, depression and anxiety subscale scores were discerned between the NT and WT groups. Psychological well-being and distress were moderately and negatively correlated (rs = -.56). Multivariate analysis indicated that ear pain and psychological distress increased the prospect of painful TMDs. CONCLUSION The prevalence of multi-site bodily pain was high in young people from CHCs irrespective of the painful TMDs' presence of painful TMDs. Enhancing environmental mastery and relieving depression/anxiety may help manage TMD pain.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore City, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore City, Singapore
| | - Darren Zong Ru Lee
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore City, Singapore
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Yap AU, Marpaung C. Personality, psychosocial and oral behavioural risk factors for temporomandibular disorder symptoms in Asian young adults. J Oral Rehabil 2023; 50:931-939. [PMID: 37256928 DOI: 10.1111/joor.13527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/16/2023] [Accepted: 05/28/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The relation between personality, psychosocial factors, somatisation, andoral behaviours as risk factors to temporomandibular disorder symptoms have notbeen well established. OBJECTIVES This study examined the association of temporomandibular disorder (TMD) symptoms with personality traits, psychological distress, somatisation and oral behaviours. The psychosocial and oral behavioural risk factors for TMD symptoms were also established in Asian young adults. METHODS Participants were recruited from a large private University. Based on the quintessential five TMD symptoms (5Ts) of the DC/TMD, the participants were stratified into those with no (NT), painful (PT), dysfunctional (DT) and mixed (MT) TMD symptoms. Personality traits, psychological distress, somatisation and oral behaviours were evaluated with the Big Five Inventory-10 (BFI-10), Depression, Anxiety, Stress Scales-21 (DASS-21), Patient Health Questionnaire-15 (PHQ-15) and Oral Behaviours Checklist (OBC) accordingly. Data were examined using Kruskal-Wallis/Mann-Whitney U and Chi-squared tests, as well as multivariate logistic regression analysis (α = .05). RESULTS Of the 420 young adults (mean age 22.7 ± 1.1 years) evaluated, 41.4% had no TMD symptoms, while 17.4%, 20.0% and 21.2% reported PT, DT and MT, respectively. Though personality traits did not vary notably, participants with MT and PT had significantly higher levels of negative affectivity, anxiety and stress than the NT group. Moreover, those with MT and PT presented significantly greater somatisation and more oral behaviours than the DT and NT groups. Multivariate regression analyses indicated that anxiety, somatisation, sleep-related and waking-state nonfunctional oral activities were associated with painful and/or dysfunctional TMD symptoms. CONCLUSIONS Except for sleep-related oral activity, psychosocial and oral behavioural risk factors differed for painful, dysfunctional and mixed TMD symptoms in Asian young adults.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore City, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore City, Singapore
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
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Saghafi E, Andås CA, Bernson J, Kjeller G. Patients' experiences of adverse symptoms, emotions, and coping strategies in connection to treatment of head and neck cancer - an interview study. BMC Oral Health 2023; 23:641. [PMID: 37670339 PMCID: PMC10478420 DOI: 10.1186/s12903-023-03366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aimed to increase the understanding of emotions and coping strategies used by head and neck cancer patients before cancer treatment, and to explore their emotions and coping strategies in relation to symptoms and side effects after treatment. Furthermore, we aimed to investigate the patients' perceptions of received treatment and support. METHODS Semi-structured in-depth interviews were conducted with 10 patients who had been treated for head and neck cancer, which included radiotherapy, at the Department of Oncology and the Department of Oral and Maxillofacial Surgery at Sahlgrenska University Hospital in Gothenburg. The interviews were analyzed in accordance with the method for Qualitative Content Analysis. RESULTS The result picture revealed three head themes. The first theme "Management of simultaneously influencing mind-sets before cancer treatment" described the patients experiences of feeling "Scared and worried," "Lonely and disappointed," and "Relieved and confident", and how they tried to handle the diagnosis and preparations for treatment by "Applying a positive mind-set", "Searching for support," and "Trusting the healthcare system". The second theme "Experiences of becoming a pale shadow of oneself", illustrated experiences of affecting post-treatment symptoms and side effects. To which, the last theme "Handling contextual influencing experiences after cancer treatment" displayed post-treatment emotions of being "Shocked and disappointed" and "Concerned and unsupported" but also "Grateful and forward-thinking", where strategies such as "Appreciating Life", "Networking socially," and "Adapting to the new life" were used. CONCLUSIONS The results indicated the need for a more patient-centered care approach, with clearer structures and improved individual support both before and after treatment and in connection to rehabilitation. Patients' cognitive changes after cancer treatment should be considered in the aftercare, which should also include adaptation to situation and strengthening of patients' self-management as a goal.
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Affiliation(s)
- Ellie Saghafi
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12A, Gothenburg, 413 90, Sweden.
- Department of Orofacial Pain, Region Västra Götaland, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Charlotte Andrén Andås
- Department of Orofacial Pain, Region Västra Götaland, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Bernson
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Kjeller
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12A, Gothenburg, 413 90, Sweden
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23
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Romero-Reyes M, Arman S, Teruel A, Kumar S, Hawkins J, Akerman S. Pharmacological Management of Orofacial Pain. Drugs 2023; 83:1269-1292. [PMID: 37632671 DOI: 10.1007/s40265-023-01927-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Orofacial pain is a category of complex disorders, including musculoskeletal, neuropathic and neurovascular disorders, that greatly affect the quality of life of the patient. These disorders are within the fields of dentistry and medicine and management can be challenging, requiring a referral to an orofacial pain specialist, essential for adequate evaluation, diagnosis, and care. Management is specific to the diagnosis and a treatment plan is developed with diverse pharmacological and non-pharmacological modalities. The pharmacological management of orofacial pain encompasses a vast array of medication classes and approaches. This includes anti-inflammatory drugs, muscle relaxants, anticonvulsants, antidepressants, and anesthetics. In addition, as adjunct therapy, different injections can be integrated into the management plan depending on the diagnosis and needs. These include trigger point injections, temporomandibular joint (TMJ) injections, and neurotoxin injections with botulinum toxin and nerve blocks. Multidisciplinary management is key for optimal care. New and safer therapeutic targets exclusively for the management of orofacial pain disorders are needed to offer better care for this patient population.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, 650 W. Baltimore St, 1st Floor, Baltimore, MD, 21201, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA.
| | - Sherwin Arman
- Orofacial Pain Program, Section of Oral Medicine, Oral Pathology and Orofacial Pain, University of California, Los Angeles, School of Dentistry, Los Angeles, CA, USA
| | | | - Satish Kumar
- Department of Periodontics, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, AZ, USA
| | - James Hawkins
- Naval Postgraduate Dental School, Naval Medical Leader and Professional Development Command, Uniformed Services University of the Health Sciences Postgraduate Dental College, Baltimore, MD, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA
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24
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Yap AU, Lei J, Fu KY, Kim SH, Lee BM, Park JW. DC/TMD Axis I diagnostic subtypes in TMD patients from Confucian heritage cultures: a stratified reporting framework. Clin Oral Investig 2023; 27:4459-4470. [PMID: 37243820 DOI: 10.1007/s00784-023-05067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/07/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study proposed a conceptual framework for reporting Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I conditions and investigated the prevalence of TMD subtypes/categories in patients from Confucian heritage cultures. Variances in gender, age, and TMD chronicity between Chinese (CN) and Korean (KR) patients were also explored. MATERIALS AND METHODS Subjects were recruited from consecutive patients seeking care at two University-based centers in Beijing and Seoul. Eligible patients completed a demographic survey as well as the DC/TMD Symptom Questionnaire and were clinically examined according to the DC/TMD methodology. Axis I diagnoses were subsequently rendered with the DC/TMD algorithms and documented using the stratified reporting framework. Statistical evaluations were performed with chi-square, Mann-Whitney U tests, and logistic regression analysis (α = 0.05). RESULTS Data of 2008 TMD patients (mean age 34.8 ± 16.2 years) were appraised. Substantial differences in female-to-male ratio (CN > KR), age (KR > CN), and TMD duration (KR > CN) were observed. Ranked frequencies of the most common Axis I diagnoses were: CN - disc displacements (69.7%) > arthralgia (39.9%) > degenerative joint disease (36.7%); KR - disc displacements (81.0%) > myalgia (60.2%) > arthralgia (56.1%). Concerning TMD categories, notable differences in the prevalence of intra-articular (CN 55.1% > KR 15.4%) and combined (KR 71.8% > CN 33.4%) TMDs were discerned. CONCLUSIONS Though culturally similar, the two countries require disparate TMD care planning/prioritization. While TMJ disorders in children/adolescents and young adults should be emphasized in China, the focus in Korea would be on TMD pain in young and middle-aged adults. CLINICAL RELEVANCE Besides culture, other variables including socioeconomic, environmental, and psychosocial factors can influence the clinical presentation of TMDs. Chinese and Korean TMD patients exhibited significantly more intra-articular and combined TMDs respectively.
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Affiliation(s)
- Adrian Ujin Yap
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore
| | - Jie Lei
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Kai Yan Fu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Seong Hae Kim
- Department of Dental Biomaterials Science, Seoul National University School of Dentistry, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
| | - Byeong-Min Lee
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
| | - Ji Woon Park
- Dental Research Institute, Seoul National University, Seoul, Korea.
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea.
- Department of Oral Medicine & Oral Diagnosis, Seoul National University School of Dentistry, 101 Daehak-Ro, Jongno-Gu, Seoul, Korea.
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25
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Tchivileva IE, Johnson KW, Chai X, VanDam LR, Lim PF, Slade GD. Evaluation of Plasma Calcitonin Gene-Related Peptide as a Biomarker for Painful Temporomandibular Disorder and Migraine. J Pain Res 2023; 16:2331-2346. [PMID: 37456357 PMCID: PMC10349596 DOI: 10.2147/jpr.s408044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To assess associations of plasma calcitonin gene-related peptide (CGRP) with chronic temporomandibular disorder (TMD) myalgia/arthralgia or frequent/chronic migraine, alone and in combination, and to evaluate relations between the CGRP concentration and clinical, psychological, and somatosensory characteristics of participants. Methods The cross-sectional study selected four groups of adult volunteers: healthy controls (HCs), TMD without migraine, migraine without TMD, and TMD with migraine. Each group comprised 20 participants, providing 94% power to detect statistically significant associations with CGRP concentration for either TMD or migraine. TMD and headache were classified according to the Diagnostic Criteria for TMD and the International Classification for Headache Disorders, 3rd edition, respectively. Plasma CGRP was quantified with a validated high-sensitivity electrochemiluminescent Meso Scale Discovery assay. Questionnaires and clinical examinations were used to evaluate characteristics of TMD, headache, psychological distress, and pressure pain sensitivity. Univariate regression models quantified associations of the CGRP concentration with TMD, migraine, and their interaction. Univariate associations of the CGRP concentration with clinical, psychological, and pressure pain characteristics were also assessed. Results Among 80 participants enrolled, neither TMD nor migraine was associated with plasma CGRP concentration (P = 0.761 and P = 0.972, respectively). The CGRP concentration (mean ± SD) was similar in all 4 groups: HCs 2.0 ± 0.7 pg/mL, TMD 2.1 ± 0.8 pg/mL, migraine 2.1 ± 0.9 pg/mL, and TMD with migraine 2.2 ± 0.7 pg/mL. CGRP concentration was positively associated with age (P = 0.034) and marginally with body mass index (P = 0.080) but was unrelated to other participant characteristics. Conclusion In this well-powered study, interictal plasma concentration of CGRP was a poor biomarker for TMD and migraine.
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Affiliation(s)
- Inna E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirk W Johnson
- Pain Research, Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiyun Chai
- Precision Medicine Neuroscience, AbbVie, Chicago, IL, USA
| | | | - Pei Feng Lim
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary D Slade
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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26
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Varun S, Anderson GC, Hodges JS, Zhang L, Schiffman EL. A Controlled Study of Biopsychosocial Differences Observed in Masticatory Myalgia With and Without Pain Referral. J Oral Facial Pain Headache 2023; 37:131-138. [PMID: 37389839 PMCID: PMC10642503 DOI: 10.11607/ofph.3317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIMS To assess differences in biopsychosocial factors between participants with masticatory myofascial pain with referral (MFPwR), with myalgia without referral (Mw/oR), and community controls without TMDs. METHODS Study participants were diagnosed with MFPwR (n = 196), Mw/oR (n = 299), or as a non-TMD community control (n = 87) by two calibrated examiners at each of three study sites. Pain chronicity, pain on palpation of masticatory muscle sites, and pressure pain thresholds (PPT) at 12 masticatory muscle, 2 trigeminal, and 2 nontrigeminal control sites were recorded. Psychosocial factors assessed included anxiety, depression, and nonspecific physical symptoms (Symptom Checklist-90 Revised); stress (Perceived Stress Scale); and health-related quality of life (Short Form Health Survey). Comparisons among the three groups were adjusted for age, sex, race, education, and income using multivariable linear regression. The significance threshold was set at P = .017 (.05 / 3) for subsequent pairwise comparisons. RESULTS Compared to the Mw/oR group, the MFPwR group had significantly greater pain chronicity, number of painful muscle sites, anxiety, depression, nonspecific physical symptoms, and impaired physical health (P < .017). The MFPwR group also had significantly lower PPTs for masticatory sites (P < .017). Both muscle pain groups differed significantly from the non-TMD community control group for all outcome measures (P < .017). CONCLUSION These findings support the clinical utility of separating MFPwR from Mw/oR. Patients with MFPwR are more complex from a biopsychosocial perspective than Mw/oR patients, which likely affects prognosis and supports consideration of these factors in case management.
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27
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Patel K, Eley KA, Cascarini L, Watt-Smith S, Larkin M, Lloyd T, Maddocks C, McLaren E, Stovell R, McMillan R. Temporomandibular disorders-review of evidence-based management and a proposed multidisciplinary care pathway. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:54-69. [PMID: 36990844 DOI: 10.1016/j.oooo.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/28/2023] [Accepted: 02/05/2023] [Indexed: 02/14/2023]
Abstract
Temporomandibular disorders (TMDs) are a prevalent but complex group of conditions that cause orofacial pain. Temporomandibular disorders are recognized as one of the most common chronic pain conditions, alongside back pain and headache disorders. Given the competing theories surrounding what causes TMDs and limited high-equality evidence on optimally treating TMDs, clinicians often encounter challenges in developing an effective management plan for patients. Furthermore, patients will often seek advice from multiple health care providers from varying specialties, seeking curative management, often resulting in inappropriate treatments and no improvement in pain symptoms. Throughout this review, we explore the existing evidence base surrounding the pathophysiology, diagnosis, and management of TMDs. An existing United Kingdom-based multidisciplinary care pathway for the management of TMDs is described herein, highlighting the benefits of a multidisciplinary approach to patient care for TMDs.
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Affiliation(s)
- Krupali Patel
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK; University College London Eastman Dental Institute, London, UK
| | - Karen A Eley
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Maeve Larkin
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Lloyd
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Maddocks
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elenor McLaren
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel Stovell
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Roddy McMillan
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK; University College London Eastman Dental Institute, London, UK.
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28
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Tervahauta E, Näpänkangas R, Närhi L, Tolvanen M, Pirttiniemi P, Silvola AS, Sipilä K. The relation of temporomandibular disorders with oral health-related quality of life in the Northern Finland Birth Cohort 1966. Cranio 2023:1-11. [PMID: 37343001 DOI: 10.1080/08869634.2023.2226829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between temporomandibular disorders (TMD) and oral health-related quality of life (OHRQoL) in an adult population. METHODS The data included 1,768 adults 46 years of age in the Northern Finland Birth Cohort 1966 (NFBC1966) study. The symptoms, signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and validated questionnaires. OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Associations of TMD and OHRQoL were evaluated with χ2 -test and Fisher's exact test. RESULTS In females, pain-related TMD signs and diagnoses associated significantly with prevalence of OHIP total and all dimensions, whereas in joint-related TMD, psychological dimensions showed the strongest association. Males with pain- or joint-related TMD, the most impaired dimension was physical pain. CONCLUSION Pain-related TMD seems to associate more strongly with lower OHRQoL than joint-related TMD especially in females.
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Affiliation(s)
- Elisa Tervahauta
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Ritva Näpänkangas
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Linnea Närhi
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Mimmi Tolvanen
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Pertti Pirttiniemi
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Anna-Sofia Silvola
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Kirsi Sipilä
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
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Rentsch M, Zumbrunn Wojczyńska A, Gallo LM, Colombo V. Prevalence of Temporomandibular Disorders Based on a Shortened Symptom Questionnaire of the Diagnostic Criteria for Temporomandibular Disorders and Its Screening Reliability for Children and Adolescents Aged 7-14 Years. J Clin Med 2023; 12:4109. [PMID: 37373802 DOI: 10.3390/jcm12124109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
The prevalence and adequacy of diagnostic approaches for temporomandibular disorders (TMD) in children and adolescents are still matters of debate. This study aimed to determine the prevalence of TMD and oral habits in children and adolescents aged 7-14 years and evaluate the consistency between self-reported TMD symptoms and clinical findings using a shortened Axis I of Diagnostic Criteria for TMD (DC/TMD). Children (aged 7-10) and adolescents (aged 11-14) of both sexes were invited to participate in this study (n = 1468). Descriptive statistics for all observed variables and Mann-Whitney U-Tests for the clinical examination were performed. A total of 239 subjects participated in the study (response rate 16.3%). The self-reported prevalence of TMD was found to be 18.8%. The most frequently reported oral habit was nail biting (37.7%), followed by clenching (32.2%) and grinding (25.5%). Self-reported headache increased with age, while clenching and grinding decreased. Based on the answers to the DC/TMD Symptom Questionnaire, subgroups of asymptomatic and symptomatic participants (n = 59; 24.7%) were established and randomly selected for the clinical examination (f = 30). The shortened Symptom Questionnaire showed a sensitivity of 0.556 and a specificity of 0.719 for pain during the clinical examination. Although the Symptom Questionnaire exhibited high specificity (0.933), its sensitivity (0.286) for temporomandibular joint sounds was low. Disc displacement with reduction (10.2%) and myalgia (6.8%) were the most common diagnoses. In conclusion, the self-reported prevalence of TMD in children and adolescents in this study was comparable to that reported in the literature for adults. However, the accuracy of the shortened Symptom Questionnaire as a screening tool for TMD-related pain and jaw sounds in children and adolescents was found to be low.
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Affiliation(s)
- Mathias Rentsch
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
- Public-School Dental Services of the City of Zurich, 8002 Zurich, Switzerland
| | | | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Vera Colombo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
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30
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Sadighparvar S, Al-Hamed FS, Sharif-Naeini R, Meloto CB. Preclinical orofacial pain assays and measures and chronic primary orofacial pain research: where we are and where we need to go. FRONTIERS IN PAIN RESEARCH 2023; 4:1150749. [PMID: 37293433 PMCID: PMC10244561 DOI: 10.3389/fpain.2023.1150749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023] Open
Abstract
Chronic primary orofacial pain (OFP) conditions such as painful temporomandibular disorders (pTMDs; i.e., myofascial pain and arthralgia), idiopathic trigeminal neuralgia (TN), and burning mouth syndrome (BMS) are seemingly idiopathic, but evidence support complex and multifactorial etiology and pathophysiology. Important fragments of this complex array of factors have been identified over the years largely with the help of preclinical studies. However, findings have yet to translate into better pain care for chronic OFP patients. The need to develop preclinical assays that better simulate the etiology, pathophysiology, and clinical symptoms of OFP patients and to assess OFP measures consistent with their clinical symptoms is a challenge that needs to be overcome to support this translation process. In this review, we describe rodent assays and OFP pain measures that can be used in support of chronic primary OFP research, in specific pTMDs, TN, and BMS. We discuss their suitability and limitations considering the current knowledge of the etiology and pathophysiology of these conditions and suggest possible future directions. Our goal is to foster the development of innovative animal models with greater translatability and potential to lead to better care for patients living with chronic primary OFP.
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Affiliation(s)
- Shirin Sadighparvar
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- The Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | | | - Reza Sharif-Naeini
- The Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Department of Physiology and Cell Information Systems, McGill University, Montreal, QC, Canada
| | - Carolina Beraldo Meloto
- The Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
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31
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Thomas S, Wang Y, Cundiff-O’Sullivan R, Massalee R, Colloca L. How negative and positive constructs and comorbid conditions contribute to disability in chronic orofacial pain. Eur J Pain 2023; 27:99-110. [PMID: 36203350 PMCID: PMC9799734 DOI: 10.1002/ejp.2042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/08/2022] [Accepted: 10/02/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMD) symptoms develop into chronic pain for some patients, but the reasons for this are unclear. Psychosocial factors and chronic overlapping pain conditions are believed to contribute to the development of pain-related disability. We examined the role of jaw function, negative and positive psychological factors and chronic overlapping pain conditions (COPCs) on pain-related disability whilst controlling for demographic variables. METHODS We collected demographics, medical and psychosocial history and the Graded Chronic Pain Scale, a measure of pain intensity and pain interference from 400 participants with chronic TMD. Structural equation modelling was used to assess a model of COPCs and the latent variables of psychological unease (pain catastrophizing, somatic symptoms and negative affect), positive valence factors (optimism and positive affect), jaw function (chewing, opening and expression limitation) and pain-related disability (pain intensity and pain interference) whilst controlling for demographic variables. RESULTS We achieved good fit of a parsimonious model (root-mean-square error of approximation = 0.063 [90% CI] [0.051-0.075]), comparative fit index = 0.942, standard root-mean-square residual = 0.067. Jaw function was the strongest latent variable predictor, followed by psychological unease and COPCs suggesting resources focused on improving joint function, psychosocial support and management of COPCs will improve pain-related disability in TMDs. CONCLUSIONS These findings not only increase the body of knowledge related to TMD clinical phenotypes but also, have a translational impact in further supporting the potential value of targeting physical therapy such as jaw exercise along with psychological interventions as multidisciplinary nonpharmacological therapeutic solutions.
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Affiliation(s)
- Sharon Thomas
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Yang Wang
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
| | - Rachel Cundiff-O’Sullivan
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
- Program in Neuroscience, Graduate Program in Life Sciences, University of Maryland, Baltimore, MD, US
| | - Rachel Massalee
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
| | - Luana Colloca
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Departments of Anaesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, USA
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
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32
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Banafa A, Suominen AL, Sipilä K. Association between cynical hostility and temporomandibular pain mediated through somatization and depression: an 11-year follow-up study on Finnish adults. Acta Odontol Scand 2023; 81:79-85. [PMID: 35731236 DOI: 10.1080/00016357.2022.2085323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hostility is believed to have an adverse effect on physical health through mediating psychosocial factors. OBJECTIVES This study aimed to investigate the association of hostility with temporomandibular (TMD) pain. Another aim was to investigate if the association is mediated through increases in depressiveness and somatization in an 11-year follow-up on Finnish adults, based on the Health 2000 and 2011 Surveys (BRIF8901). MATERIAL AND METHODS The sample comprised subjects who underwent clinical TMD pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TMD pain symptoms in 2011. Hostility was measured using the Cynical Distrust Scale, somatization was measured using the Symptom Checklist-90, and depressiveness using Beck's Depression Inventory-21. Four subgroups were formed based on the presence of TMD pain: no pain, pain in 2000 only, pain in 2011 only, and pain in 2000 and 2011. Analyses included chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hostility in 2000 as the predictor. Mediation analysis was performed using Hayes' Process v3.5. RESULTS Those with higher hostility showed a higher prevalence of TMD pain. Longitudinally, the association of hostility with TMD pain in 2000 only, and with TMD pain in both years, was mediated either by somatization only or by depressiveness that was mediated by somatization. In those with TMD pain in 2011 only, the association was mediated by depressiveness that was mediated by somatization. CONCLUSION Hostility increased the risk of TMD pain through increases in depressiveness and somatization.
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Affiliation(s)
- Aisha Banafa
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
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Mitrowska-Guźmińska M, Gębska M, Jonko K, Dalewski B, Pałka Ł, Chęć M, Sobolewska E. Effect of Personality Type on the Occurrence of Temporomandibular Disorders-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:352. [PMID: 36612672 PMCID: PMC9819750 DOI: 10.3390/ijerph20010352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Personality traits are one of the major factors influencing the behavior and functioning of an individual, and they play a crucial role in the development of psychosomatic disorders and diseases. This paper aimed to evaluate the importance of personality traits in temporomandibular disorder (TMDs) development using the NEO-FFI Personality Inventory by Paul Costa and Robert McCrae (the Five-Factor Model of Personality, known as the Big Five). Moreover, the relationship between personality type and the intensity of dysfunctional changes in the stomatognathic system was assessed using the NEO-FFI Personality Inventory by Paul Costa and Robert McCrae (the Five-Factor Model of Personality, known as the Big Five). MATERIAL AND METHODS The study included a group of 75 adult participants (aged 19-52) with TMD diagnosed according to DC/TMD criteria and a control group of 75 participants without symptoms of dysfunction. The study consisted of a questionnaire and clinical study; the questionnaire included the NEO-FFI psychological questionnaire and a self-authored one. The clinical part consisted of extra- and intraoral dental examinations. RESULTS Participants who clenched their teeth showed a greater degree of conscientiousness than those who did not exhibit this symptom (p = 0.048). Presence of headaches was correlated with greater severity of neuroticism (p = 0.001). Moreover, participants with enamel cracks showed a lower intensity of extraversion (p = 0.039), and those with worn hard dental tissues showed a higher intensity of neuroticism (p = 0.03), a lower intensity of conscientiousness (p = 0.01), and a lower intensity of extroversion (p = 0.046). Acoustic symptoms during mandibular movements were found to be linked with a higher level of neuroticism (p = 0.020), a lower level of extraversion (p = 0.035), and a lower level of conscientiousness, whereas pain upon mandibular movements were linked to a lower level of conscientiousness (p = 0.025). Participants with pain upon palpation of the masticatory muscles showed a lower level of conscientiousness (p = 0.01) compared to those without pain symptoms. Episodes of mandibular blockage or problems with its adduction depend on the intensity of conscientiousness (p = 0.007). Moreover, people from the study group with high levels of neuroticism showed lower protrusion values (p = 0.016). CONCLUSION The intensity of individual personality traits was found to be associated with some TMDs in comparison to healthy controls.
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Affiliation(s)
| | - Magdalena Gębska
- Department of Rehabilitation Musculoskeletal System, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Kinga Jonko
- Department of Dental Prosthetics, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Bartosz Dalewski
- Department of Dental Prosthetics, Pomeranian Medical University, 70-204 Szczecin, Poland
| | | | - Magdalena Chęć
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, Krakowska 69, 71-017 Szczecin, Poland
| | - Ewa Sobolewska
- Department of Dental Prosthetics, Pomeranian Medical University, 70-204 Szczecin, Poland
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Asquini G, Devecchi V, Borromeo G, Viscuso D, Morato F, Locatelli M, Falla D. Predictors of pain reduction following a program of manual therapies for patients with temporomandibular disorders: A prospective observational study. Musculoskelet Sci Pract 2022; 62:102634. [PMID: 35939919 DOI: 10.1016/j.msksp.2022.102634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy (MT) is commonly applied to reduce pain and improve function. OBJECTIVES To identify predictors of pain reduction and functional improvement following a program of manual therapies (MTP) in patients with TMD and develop a first screening tool that could be used in clinical practice to facilitate decision-making. DESIGN A cohort of 102 adults with a diagnosis of TMD were treated with four weekly sessions within a MTP applied to craniomandibular structures. Candidate predictors were demographic variables, general health variables, psychosocial features, TMD characteristics and related clinical tests. A reduction of pain intensity by at least 30% after the MTP was considered a good outcome. Logistic regression was adopted to develop the predictive model and its performance was assessed considering the explained variance, calibration, and discrimination. Internal validation of the prediction models was further evaluated in 500 bootstrapped samples. RESULTS Patients experiencing pain intensity greater than 2/10 during mouth opening, positive expectations of outcome following a MTP, pain localized in the craniocervical region, and a low Central Sensitization Inventory score obtained a good outcome following the MTP. Predictive performance of the identified physical and psychological variables was characterized by high explained variance (R2 = 58%) and discrimination (AUC = 89%) after internal validation. A preliminary screening clinical tool was developed and presented as a nomogram. CONCLUSIONS The high discrimination of the prediction model revealed promising findings, although these need to be externally validated in future research. TRIAL REGISTRATION NUMBER NCT03990662.
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Affiliation(s)
- Giacomo Asquini
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK; Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK
| | - Giulia Borromeo
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Domenico Viscuso
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy; University of Cagliari, Department of Surgical Sciences, Dental Service, Via Università 40 Cagliari, Italy
| | - Federico Morato
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Matteo Locatelli
- IRCCS San Raffaele Scientific Institute, Via Olgettina Milano 60, 20132, Milano, Italy
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK.
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Muacevic A, Adler JR, Al Mazyad B, Al Yousef S, Hatab Alanazi S. The Association Between Post-Traumatic Stress Disorder and Temporomandibular Disorders: A Systematic Review. Cureus 2022; 14:e31896. [PMID: 36579250 PMCID: PMC9792336 DOI: 10.7759/cureus.31896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
Abstract
The purpose of this systematic study was to discover a connection between temporomandibular joint disorders and post-traumatic stress disorder. A systematic review of observational studies on post-traumatic stress disorder and the incidence of temporomandibular joint disorders (TMD) was conducted. Electronic searches of PubMed, the Saudi Digital Library, Science Direct, the Virtual Health Library (VHL), Scopus, Web of Science, Sage, EBSCO Information Services, and Ovid were performed. There was a consensus among the reviewing examiners. Only studies with the following Medical Subject Headings (MeSH) terms were included: "Posttraumatic stress disorder" combined with "temporomandibular joint disorder," "myofascial pain," "orofacial pain," "internal derangement," "disc displacement with reduction," or "disc displacement without reduction." Only full-text studies in the English language published between 2010 and June 2020 were considered. Of a total of 381 articles meeting the initial screening criteria, only eight were included in the qualitative analysis. Overall, pain is exacerbated in patients with PTSD; that is, their TMD is heightened in all aspects of pain, chronicity, decreased response to conventional therapies, and the need for more potent treatment options as compared with patients with just TMD. The evidence, albeit weak, obtained from the studies included in this review suggests a relationship between PTSD and TMDs.
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Prevalence of Temporomandibular Disorder-Related Pain among Adults Seeking Dental Care: A Cross-Sectional Study. Int J Dent 2022; 2022:3186069. [PMID: 36105380 PMCID: PMC9467697 DOI: 10.1155/2022/3186069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Temporomandibular disorders (TMD) are a constellation of painful conditions that affect the craniofacial complex. The etiology and risk factors of these conditions have been extensively studied; however, the data available describing the epidemiology of TMD in the Middle East are scarce. We aimed to estimate the prevalence and risk factors of TMD-related pain in a sample population of dental school clinic patients. Methods This observational cross-sectional study used a translated and culturally adapted temporomandibular disorders pain screener, a part of the Diagnostic Criteria/Temporomandibular Disorders (DC/TMD) criteria instrument, and questions related to demographic characteristics and risk factors for TMD. Data were analyzed through chi-square and Mann–Whitney U tests using SPSS. Results The sample population included 199 participants (66% female and 34% male). The prevalence of TMD-related pain was 26.8% (n = 42); men and women did not differ statistically in their TMD-related pain. TMD-related pain cases differed significantly on the Center for Epidemiologic Studies Depression Scale (CES-D) and body pain scores compared with noncases. Conclusion The prevalence of TMD-related pain in the clinical sample population was high. Hence, the onus is on dental health services to screen and educate patients on TMD conditions regularly.
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The Role of Pain Inflexibility and Acceptance among Headache and Temporomandibular Disorders Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137974. [PMID: 35805650 PMCID: PMC9265370 DOI: 10.3390/ijerph19137974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 01/27/2023]
Abstract
Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association.
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Mullins RJ, Meeker TJ, Vinch PM, Tulloch IK, Saffer MI, Chien JH, Bienvenu OJ, Lenz FA. A Cross-Sectional Time Course of COVID-19 Related Worry, Perceived Stress, and General Anxiety in the Context of Post-Traumatic Stress Disorder-like Symptomatology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7178. [PMID: 35742432 PMCID: PMC9222603 DOI: 10.3390/ijerph19127178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic within the United States of America resulted in over 800,000 deaths as of February 2022 and has been addressed by social distancing or stay-at-home measures. Collective prolonged multimodal trauma on this scale is likely to elicit symptomatology in the general population consistent with post-traumatic stress disorder (PTSD), somatization, anxiety, and stress. The psychological component of this response contributes substantially to the burden of this disease worldwide. This cross-sectional study examines the relationship between COVID-19-related concern, anxiety, and perceived stress on PTSD-like symptomatology over the course of the COVID-19 pandemic. Participants were recruited via social media within the United States of America between 8th May 2020 and 11th August 2021 to complete an internet questionnaire including mood, personality, and COVID-19-specific scales. General anxiety and PTSD-like symptomatology were above the screening cutoffs for most respondents. These measures increased in severity over the pandemic, with the change point of our Concern scale preceding that of the other significant measures. Measures of COVID-19-related concern, generalized anxiety, and PTSD-like symptomatology were strongly correlated with each other. Anxiety, perceived stress, and PTSD-like symptomatology are strongly interrelated, increase with pandemic length, and are linked to reported levels of concern over COVID-19. These observations may aid future research and policy as the pandemic continues.
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Affiliation(s)
- Roger J. Mullins
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA; (R.J.M.); (P.M.V.); (M.I.S.); (J.-H.C.); (F.A.L.)
| | - Timothy J. Meeker
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA; (R.J.M.); (P.M.V.); (M.I.S.); (J.-H.C.); (F.A.L.)
| | - Paige M. Vinch
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA; (R.J.M.); (P.M.V.); (M.I.S.); (J.-H.C.); (F.A.L.)
| | - Ingrid K. Tulloch
- Department of Psychology, Morgan State University, Baltimore, MD 21251, USA;
| | - Mark I. Saffer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA; (R.J.M.); (P.M.V.); (M.I.S.); (J.-H.C.); (F.A.L.)
| | - Jui-Hong Chien
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA; (R.J.M.); (P.M.V.); (M.I.S.); (J.-H.C.); (F.A.L.)
| | - O. Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Frederick A. Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA; (R.J.M.); (P.M.V.); (M.I.S.); (J.-H.C.); (F.A.L.)
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Schroeter AC, MacDonald DA, Scholten-Peeters GGM, Goubert L, Kendall E, Coppieters MW. Preferred self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. A modified Delphi study. PAIN MEDICINE 2022; 23:1891-1901. [DOI: 10.1093/pm/pnac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
The plethora of self-administered questionnaires to assess positive psychosocial factors complicates questionnaire selection. This study aimed to identify and reach consensus on the most suitable self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain.
Design
A three-round modified Delphi study.
Participants
Forty international experts.
Methods
In Round 1, the experts suggested questionnaires deemed appropriate to assess resilience, optimism, pain acceptance and/or social support. In Round 2, experts indicated whether they considered the suggested questionnaires to be suitable (Yes/No/Don’t know) to assess these psychosocial factors, taking into consideration content, feasibility, personal experience and the measurement properties which we provided for each questionnaire. Questionnaires that were considered suitable by the majority of experts (≥60%) were retained for Round 3. In Round 3, the suitability of each questionnaire was rated on a 0–10 Likert scale. Consensus was reached if ≥ 75% of experts rated the questionnaire ≥7.
Results
From the 67 questionnaires suggested in Round 1, one questionnaire could be recommended per domain. For resilience: Pain Resilience Scale; for optimism: Revised Version of the Life Orientation Test; for pain acceptance: 8-item and Revised Versions of the Chronic Pain Acceptance Questionnaire; for social support: Emotional Support Item Bank of the PROMIS tool. Consensus for these questionnaires was also reached in a sensitivity analysis which excluded the ratings of experts involved in the development, translation and/or validation of relevant questionnaires.
Conclusion
We advocate the use of these recommended questionnaires so data can be compared and pooled more easily.
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Affiliation(s)
- Andrea C Schroeter
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | - David A MacDonald
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | | | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
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Saghafi E, Tuomi L, Kjeller G. The prevalence and symptoms of temporomandibular disorders in head and neck cancer patients. Acta Odontol Scand 2022; 80:252-257. [PMID: 34651551 DOI: 10.1080/00016357.2021.1991470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This retrospective patient survey aimed to assess the prevalence of temporomandibular disorders (TMD) before and after curative oncological treatment and to identify possible risk factors. MATERIALS AND METHODS Patients with squamous cell carcinoma in the tonsil or base of the tongue were included (n = 217). Medical records were collected to assess TMD prevalence before oncological treatment and at 6- and 12-month follow-up. Fisher's test and Pitman's test were used. RESULTS Significantly reduced mouth opening was observed after oncological treatment at 6- and 12-month follow-up (p < .001). Symptoms from the temporomandibular joint and jaw muscles plus pain upon palpation (p = .0083, p < .001, respectively) and self-reported pain upon chewing (<0.001) and opening the mouth (<0.001) increased 12 months following radiotherapy. Pain and degree of mouth opening prior to treatment, self-reported depression, overall health status, brachytherapy and jaw exercise during radiotherapy were factors affecting the increase of TMD symptoms. CONCLUSION All TMD symptoms escalated significantly one year after radiotherapy except self-reported sounds from the temporomandibular joint. Reduction in the degree of mouth opening and pain in the jaw muscles and the temporomandibular joint when opening the mouth and upon chewing were commonly reported symptoms following radiotherapy. Several potential risk factors were identified.
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Affiliation(s)
- Ellie Saghafi
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orofacial Pain, Region Västra Götaland, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Kjeller
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cayrol T, Meeus M, Aron V, Gatto C, Mouraux A, Roussel N, Sallaz L, van den Broeke E, Pitance L. Evidence for alterations to dynamic quantitative sensory tests in patients with chronic temporomandibular myalgia: a systematic review of observational studies with meta-analysis. J Oral Rehabil 2022; 49:654-670. [PMID: 35342987 DOI: 10.1111/joor.13320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Conflicting results exist between somatosensory profiles of patients with temporomandibular myalgia (TMDm). The objective of this review was to examine whether adults with TMDm show altered responses to dynamic quantitative sensory tests compared with healthy controls. METHODS We searched five electronic databases for studies, excluding those without suitable controls or where TMDm was associated with confounding non-musculoskeletal disorders. Risk of bias was assessed with the SIGN case-control study checklist. Findings were structured around dynamic quantitative sensory tests and their localization. Where possible, we performed meta-analysis with a random inverse variance model to compare patients with TMDm and healthy controls. Statistical heterogeneity was estimated with Chi² test and inconsistency index, I². RESULTS We extracted data from 23 studies comprising 1284 adults with chronic TMDm and 2791 healthy controls. Risk of bias was assessed as high for 20 studies. Mechanical temporal summation, the most studied phenomenon (14 studies), is increased in the upper limb of patients with TMDm (SMD = .43; 95% CI: .11 to .75; p = .0001) but not in the jaw area (p = .09) or in the cervical area (p = .29). Very little evidence for altered thermal temporal summation (five studies), conditioned pain modulation (seven studies), exercise-induced hypoalgesia (two studies), placebo analgesia (two studies), stress-induced hypoalgesia (one study) and offset analgesia (one study) was found. DISCUSSION A major limitation of this review was the risk of bias of included studies. Future studies would benefit from following methodological guidelines and consideration of confounding factors.
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Affiliation(s)
- Timothée Cayrol
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Vladimir Aron
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Claire Gatto
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - André Mouraux
- Institute of Neuroscience (IoNS), Université Catholique de Louvain, Brussels, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, Belgium
| | - Léo Sallaz
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Laurent Pitance
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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Louca Jounger S, Christidis N, Hedenberg-Magnusson B, List T, Svensson P, Schalling M, Ernberg M. Polymorphisms in the HTR2A and HTR3A Genes Contribute to Pain in TMD Myalgia. FRONTIERS IN ORAL HEALTH 2022; 2:647924. [PMID: 35047998 PMCID: PMC8757775 DOI: 10.3389/froh.2021.647924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The aim of this study was to investigate if single nucleotide polymorphisms (SNPs) related to monoaminergic neurotransmission, in particular the serotonergic pathway, contribute to pain perception in patients with temporomandibular disorder (TMD) myalgia and if there is a correlation to jaw function as well as psychosocial factors such as stress, anxiety and depression. Materials and Methods: One hundred and seventeen individuals with TMD myalgia were included. A venous blood or saliva sample was taken for genetic analyses and genotyped regarding HTR2A (rs9316233) HTR3A (rs1062613), HTR3B (rs1176744), SERT (5-HTTLPR) and COMT (rs4680). A clinical examination according to Diagnostic Criteria for TMD (DC/TMD) was performed and axis II data (psychosocial factors) were compared between participants with different genotypes for each gene using Kruskall–Wallis test. The characteristic pain intensity (CPI) was tested for correlations to scores for the Perceived Stress Scale, Generalized Anxiety Disorder, and Patient Health Questionnaires using Spearman's rank correlation test with Bonferroni correction for multiple testing. To further explore data factor analysis was performed to identify latent factors associated to the outcome variables. Results: Participants carrying at least one copy of the rare allele of the HTR2A (rs9316233) and HTR3A (rs1062613) had higher CPI compared with the participants with the homozygous common genotype (P = 0.042 and P = 0.024, respectively). Correlation analyses showed several significant positive correlations between CPI on one hand, and self-reported psychosocial distress and jaw function on the other hand for several genotypes that mostly were weak to moderate. The factor analysis identified two latent variables. One was positively correlated to the HTR3B gene, jaw function and self-reported parafunctions, and the other was positively correlated to psychological distress and negatively correlated to SERT. Conclusion: Taken together, the polymorphism rs1062613 in the HTR3A gene contributes to pain intensity in TMD myalgia. This together with positive interactions between pain variables and psychological factors in genotypes strengthens that pain and psychological distress are related. Further research is needed to explore this as well as the influence of gene-to-gene interactions on pain and psychological distress.
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Affiliation(s)
- Sofia Louca Jounger
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Britt Hedenberg-Magnusson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.,Department of Orofacial Pain and Jaw Function, Folktandvården Eastmaninstitutet, Stockholm, Sweden
| | - Thomas List
- Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Peter Svensson
- Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, University of Aarhus, Aarhus, Denmark
| | - Martin Schalling
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
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Aternali A, Slepian PM, Clarke H, Ladha KS, Katznelson R, McRae K, Seltzer Z, Katz J. Presurgical distress about bodily sensations predicts chronic postsurgical pain intensity and disability 6 months after cardiothoracic surgery. Pain 2022; 163:159-169. [PMID: 34086627 DOI: 10.1097/j.pain.0000000000002325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic postsurgical pain (CPSP) and disability after cardiothoracic surgery are highly prevalent and difficult to treat. Researchers have explored a variety of presurgical risk factors for CPSP and disability after cardiothoracic surgery, including one study that examined distress from bodily sensations. The current prospective, longitudinal study sought to extend previous research by investigating presurgical distress about bodily sensations as a risk factor for CPSP and disability after cardiothoracic surgery while controlling for several other potential psychosocial predictors. Participants included 543 adults undergoing nonemergency cardiac or thoracic surgery who were followed over 6 months postsurgically. Before surgery, participants completed demographic, clinical, and psychological questionnaires. Six months after surgery, participants reported the intensity of CPSP on a 0 to 10 numeric rating scale and pain disability, measured by the Pain Disability Index. Multinomial logistic regression analyses were conducted to evaluate the degree to which presurgical measures predicted pain outcomes 6 months after surgery. The results showed that CPSP intensity was significantly predicted by age and presurgical scores on the Symptom Checklist-90-Revised Somatization subscale (Nagelkerke R2 = 0.27, P < 0.001), whereas chronic pain disability was only predicted by presurgical Symptom Checklist-90-Revised Somatization scores (Nagelkerke R2 = 0.29, P < 0.001). These findings demonstrate that presurgical distress over bodily sensations predicts greater chronic pain intensity and disability 6 months after cardiothoracic surgery and suggest that presurgical treatment to diminish such distress may prevent or minimize CPSP intensity and disability.
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Affiliation(s)
- Andrea Aternali
- Department of Psychology, York University, Toronto, ON, Canada
| | - P Maxwell Slepian
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Department of Anesthesia and Pain Management, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - Ze'ev Seltzer
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
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Li YX, Li JH, Guo Y, Tao ZY, Qin SH, Traub RJ, An H, Cao DY. Oxytocin inhibits hindpaw hyperalgesia induced by orofacial inflammation combined with stress. Mol Pain 2022; 18:17448069221089591. [PMID: 35266833 PMCID: PMC9047792 DOI: 10.1177/17448069221089591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Oxytocin (OT) is recognized as a critical neuropeptide in pain-related disorders. Chronic pain caused by the comorbidity of temporomandibular disorder (TMD) and fibromyalgia syndrome (FMS) is common, but whether OT plays an analgesic role in the comorbidity of TMD and FMS is unknown. Female rats with masseter muscle inflammation combined with 3-day forced swim (FS) stress developed somatic hypersensitivity, which modeled the comorbidity of TMD and FMS. Using this model, the effects of spinal OT administration on mechanical allodynia and thermal hyperalgesia in hindpaws were examined. Furthermore, the protein levels of OT receptors and 5-HT2A receptors in the L4-L5 spinal dorsal horn were analyzed by Western blot. The OT receptor antagonist atosiban and 5-HT2A receptor antagonist ritanserin were intrathecally injected prior to OT injection in the separate groups. Intrathecal injection of 0.125 μg and 0.5 μg OT attenuated the hindpaw hyperalgesia. The expression of OT receptors and 5-HT2A receptors in the L4-L5 spinal dorsal horn significantly increased following intrathecal injection of 0.5 μg OT. Intrathecal administration of either the OT receptor antagonist atosiban or 5-HT2A receptor antagonist ritanserin blocked the analgesic effect of OT. These results suggest that OT may inhibit hindpaw hyperalgesia evoked by orofacial inflammation combined with stress through OT receptors and/or 5-HT2A receptors, thus providing a therapeutic prospect for drugs targeting the OT system and for patients with comorbidity of TMD and FMS.
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Affiliation(s)
- Yue-Xin Li
- Key Laboratory of Shaanxi Province
for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi’an Jiaotong University College of
Stomatology, China
- Department of Special Dental Care, Xi’an Jiaotong University College of
Stomatology, China
| | - Jia-Heng Li
- Key Laboratory of Shaanxi Province
for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi’an Jiaotong University College of
Stomatology, China
| | - Yi Guo
- Key Laboratory of Shaanxi Province
for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi’an Jiaotong University College of
Stomatology, China
| | - Zhuo-Ying Tao
- Key Laboratory of Shaanxi Province
for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi’an Jiaotong University College of
Stomatology, China
| | - Shi-Hao Qin
- Key Laboratory of Shaanxi Province
for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi’an Jiaotong University College of
Stomatology, China
- Department of Special Dental Care, Xi’an Jiaotong University College of
Stomatology, China
| | - Richard J Traub
- Department of Neural and Pain
Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland
Baltimore, Baltimore, MD, USA
| | - Hong An
- Department of Special Dental Care, Xi’an Jiaotong University College of
Stomatology, China
| | - Dong-Yuan Cao
- Key Laboratory of Shaanxi Province
for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi’an Jiaotong University College of
Stomatology, China
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Zhu R, Zhang L, Zheng YH, Zhang ZH, Zhang LM, Yang HL, Yue Y, Xiong X. Association between Stigma and Pain in Patients with Temporomandibular Disorders. Int J Clin Pract 2022; 2022:2803540. [PMID: 36212051 PMCID: PMC9519306 DOI: 10.1155/2022/2803540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aims to explore the association between stigma and pain in patients with temporomandibular disorders (TMDs). METHODS Two hundred and twenty-five patients with TMDs were recruited, and they completed the questionnaires including the Visual Analogue Scale of Pain (VAS), Generalized Anxiety Disorder 7-Item (GAD-7), the Patient Health Questionnaire 9-item (PHQ-9), Jaw Functional Limitation Scale 8-item (JFLS-8), the Stigma Scale for Chronic Illness 8-item (SSCI-8), and other demographic and disease-related information. The total score of SSCI-8 indicated overall stigma, which could be classified into 2 subdomains, felt stigma and enacted stigma, according to their representative items, respectively. Then, the patients were divided into 2 groups in each subdomain of stigma according to their scores: stigma group (score ≥ 1) and no stigma group (score = 0). RESULTS Patients with overall stigma and enacted stigma presented significantly higher scores in VAS, GAD-7, PHQ-9, and JFLS-8 than those without overall stigma and those without enacted stigma, respectively. Significant differences between patients with and without felt stigma were only observed in GAD-7, PHQ-9, and JFLS-8. Patients with overall stigma and enacted stigma mainly suffered from pain-related TMDs (PTs) and combined TMDs (CTs). Overall stigma and enacted stigma rather than felt stigma were significantly associated with both PTs and CTs. Stigma, including overall stigma, enacted stigma, and felt stigma, was more associated with anxiety and depression and less related to jaw functional limitation of the patients with TMDs. CONCLUSION Stigma, specifically enacted stigma, was correlated to pain in patients with TMDs. Stigma was more related to psychological problems than jaw functional limitation.
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Affiliation(s)
- Rui Zhu
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Li Zhang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yun-Hao Zheng
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zi-Han Zhang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Li-Ming Zhang
- Rehabilitation Medicine Center, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao-Lun Yang
- Rehabilitation Medicine Center, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Yue
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Xin Xiong
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Gębska M, Dalewski B, Pałka Ł, Kołodziej Ł, Sobolewska E. The Importance of Type D Personality in the Development of Temporomandibular Disorders (TMDs) and Depression in Students during the COVID-19 Pandemic. Brain Sci 2021; 12:brainsci12010028. [PMID: 35053772 PMCID: PMC8773638 DOI: 10.3390/brainsci12010028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Magdalena Gębska
- Department of Rehabilitation Musculoskeletal System, Pomeranian Medical University, 70-204 Szczecin, Poland; (M.G.); (Ł.K.)
| | - Bartosz Dalewski
- Department of Dental Prosthetics, Pomeranian Medical University, 70-204 Szczecin, Poland; (B.D.); (E.S.)
| | - Łukasz Pałka
- Private Dental Practice, 68-200 Zary, Poland
- Correspondence:
| | - Łukasz Kołodziej
- Department of Rehabilitation Musculoskeletal System, Pomeranian Medical University, 70-204 Szczecin, Poland; (M.G.); (Ł.K.)
| | - Ewa Sobolewska
- Department of Dental Prosthetics, Pomeranian Medical University, 70-204 Szczecin, Poland; (B.D.); (E.S.)
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Type D Personality and Stomatognathic System Disorders in Physiotherapy Students during the COVID-19 Pandemic. J Clin Med 2021; 10:jcm10214892. [PMID: 34768414 PMCID: PMC8584408 DOI: 10.3390/jcm10214892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/04/2022] Open
Abstract
Background: A person’s response to stressors is largely dependent on their personality traits that affect the way stress is controlled and relieved. This article is a quantitative analysis assessing the importance of the distressed personality in the development of stomatognathic system disorders (SSDs) in physiotherapy students during the COVID-19 pandemic. Objective: The goal of the research was to assess the presence of type D personality in students with symptoms of stomatognathic system disorders. Material and Method: The research was carried out among 300 physiotherapy students. The data were collected using the form of the occurrence of symptoms of SS disorders developed for the purpose of the study and the standardized psychological DS14 questionnaire. Results: In a group of 300 students, the presence of type D personality was found in 160 people (53.3%). People with type D personality had symptoms of SS disorders more often than the group without stressful personality traits. There was a significant difference between the groups regarding all the examined symptoms. In the group of people with type D personality, the most frequently reported symptoms of SS disorders included: headache (51.3%), pain in the neck and shoulder girdle (43.1%), and teeth clenching (35.6%). As many as 70% of the respondents in the group with symptoms of SS disorders (P1) had type D personality, whereas in the asymptomatic group (P2) this result was 23.3%. There was a significant difference between the groups (p = 0.00). Statistically significantly higher values of both D personality dimensions were observed in women than in men with symptoms of SS disorders. In people reporting symptoms of SS disorders, higher average values were observed in both dimensions of type D personality. There were significant differences between the groups. Conclusion: type D personality may contribute to the development of symptoms of stomatognathic disorders.
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Roithmann CC, Silva CAGD, Pattussi MP, Grossi ML. Subjective sleep quality and temporomandibular disorders: Systematic literature review and meta-analysis. J Oral Rehabil 2021; 48:1380-1394. [PMID: 34599524 DOI: 10.1111/joor.13265] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVES To assess the general subjective sleep quality in individuals with and without TMD, and its distribution among the TMD diagnostic groups. METHODS A systematic review search was performed in Pubmed/MEDLINE, Embase, LILACS, Web of Science, SciELO, CINAHL and Cochrane Central as well as in the grey literature. Observational studies published since 1992 which used either the DC/TMD or RDC/TMD for TMD diagnosis and either the PSQI, SAQ or ESS questionnaires for sleep assessment were included. Articles selected for meta-analysis underwent quality, heterogeneity and publication bias evaluation. RESULTS A total of 1071 articles were found by online search, and 10 articles were added manually. For full-text reading, 138 papers were selected. Thirty-six articles were included in the final review, and 19 in the meta-analysis (PSQI only). Subjective sleep quality was shown to be associated with all RDC/TMD or DC/TMD Axis I diagnostic groups: muscle disorders, arthralgia/osteoarthritis/osteoarthrosis and disk displacements; with the highest association in the first two groups, and the lowest in the last one. A 4.45 times increased odds ratio of TMD prevalence was found for individuals who presented poor subjective sleep quality. CONCLUSION Subjective sleep quality should be considered in the management of TMD.
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Affiliation(s)
- Camila Caspary Roithmann
- Post-Graduate Program in Dentistry (Prosthodontics), School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Carlos Augusto Gomes da Silva
- Post-Graduate Program in Dentistry (Prosthodontics), School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Marcos Pascoal Pattussi
- Post-Graduate Program in Public Health, Vale do Rio dos Sinos University (UNISINOS), São Leopoldo, Brazil
| | - Márcio Lima Grossi
- Post-Graduate Program in Dentistry (Prosthodontics), School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Banafa A, Sipilä K, Suvisaari J, Suominen AL. Low-grade inflammation as a potential mediator between depressive symptoms and temporomandibular pain: an 11-year follow-up study on Finnish adults. Acta Odontol Scand 2021; 79:545-553. [PMID: 33861677 DOI: 10.1080/00016357.2021.1909746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low-grade inflammation and depressiveness have been associated with chronic pain conditions. OBJECTIVE To examine whether low-grade inflammation mediates the association between depressive symptoms and temporomandibular (TM) pain in Finnish adults based on the Health 2000/2011 Surveys (BRIF8901). METHODS The sample comprised subjects who underwent clinical TM pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TM pain symptoms in 2011. The serum level of hs-CRP was obtained in both years, and depressiveness was assessed using the Beck Depression Inventory-21 (BDI-21) in 2000 and BDI-13 in 2011. Four subgroups were formed based on the presence of TM pain: No pain, pain in 2000-only, pain in the 2011-only, and pain in both-years. Analyses included Rao Scott's chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hs-CRP and BDI-21 score in 2000 as predictors. Mediation was tested using Hayes A. Processv3.5. RESULTS Higher BDI-21/-13 and hs-CRP levels corresponded to higher prevalences of TM pain in both years. Longitudinally, in men, higher hs-CRP level predicted TM pain in 2000-only and TM pain in both-years. Higher BDI-21 score predicted having TM pain in 2011-only. In women, higher BDI-21 score predicted TM pain in 2000-only and having TM pain in both-years. Both BDI-21 and hs-CRP had a direct effect on TM pain outcome with no mediation detected. CONCLUSION While depressiveness may increase the risk of chronic TM pain in women, the risk in men is increased by low-grade inflammation.
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Affiliation(s)
- Aisha Banafa
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Jaana Suvisaari
- Department of Public Health Solutions, Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
- Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Vrbanović E, Dešković K, Zlendić M, Alajbeg IZ. Profiling of Patients with Temporomandibular Disorders: Experience of One Tertiary Care Center. Acta Stomatol Croat 2021; 55:147-158. [PMID: 34248148 PMCID: PMC8255039 DOI: 10.15644/asc55/2/4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/14/2021] [Indexed: 10/31/2022] Open
Abstract
Objectives The aim of this study was to assess typical and most prevalent characteristics of patients suffering from temporomandibular disorders (TMD) by a retrospective assessment of their medical records. Material and Methods Demographic data and data on the characteristics of TMD were collected from the existing medical documentation of 304 TMD patients (250 females and 54 males) who had been referred to the Department of Dentistry, Clinical Hospital Center Zagreb from October 2016 to October 2020 due to temporomandibular pain. For the purpose of analysis, three age groups were formed: i) "children and adolescents" (up to 19 years of age); ii) "middle age" (from 20 to 50 years of age); iii) "older age" (>50 year- olds). A two-step cluster analysis was performed with the aim of classifying TMD patients into homogenous groups. Results The mean age of patients whose data were included in the study was 33.8 ± 16.66, with a significantly higher age in the group of women (p<0.001). Most of the patients had chronic pain (67.4%), with the ratio in favor of chronic patients being significantly higher in women than in men (p=0.001). Data on parafunctional behavior were confirmed in 14.5% of patients. Data on the onset of symptoms during/just after orthodontic treatment were present in 14.5% of patients. Data on spontaneous pain, assessed with a visual analogue scale, were recorded in 87 patients, with a mean of 6.14 ± 1.79 and with the highest pain in the "older age" group. Physical therapy was the most common therapeutic modality (56.3%) followed by an occlusal splint (40.5%). The analysis revealed 5 different clusters in the TMD patient data set. Conclusions Our results are largely in line with current epidemiological knowledge on TMD. Women predominated in all age groups and most of the patients experienced chronic pain. Classifying patients into homogeneous groups using the clustering method could provide better identification of subgroups of conditions that mainly occur together in these patients, thus providing the basis for more specific management.
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Affiliation(s)
- Ema Vrbanović
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb
| | | | - Marko Zlendić
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb
| | - Iva Z Alajbeg
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb.,Department of Dentistry, Clinical Hospital Center Zagreb, Croatia
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