Relationship between anxiety and chronic orofacial pain of temporomandibular disorder in a group of university students

The association of T102C (rs6313) polymorphism in the 5-HT2A receptor gene with temporomandibular disorders and anxiety in a group of Turkish population

OBJECTIVE

To investigate the relationship between T102C (rs6313) polymorphism in the 5-hydroxytryptamine receptor-2A (5HTR2A) gene and temporomandibular disorder (TMD) and anxiety.

METHODS

This observational case-control study included 80 patients and 70 healthy controls. TMD was diagnosed using the criteria for TMD (DC/TMD). Anxiety was assessed with the Beck anxiety scale. A genotyping study of HTRR2A T102C (rs6313) gene polymorphism was performed from genomic DNA isolated from blood.

RESULTS

The TMD group had higher anxiety scores than the control group (p < .05). The TMD group was similar to the control group regarding genotype and allele frequencies. However, the polymorphic CC genotype was more common in those with high anxiety (p < .05).

CONCLUSION

There was no clear evidence of an association between TMD and the T102C polymorphism in HTR2A and TMD. However, anxiety is closely related to the T102C polymorphism in HTR2A.

An Algorithm for Jaw Pain among Divers

Background: Temporomandibular disease (TMD) is commonly seen, and divers also experience pain in the temporomandibular joint (TMJ) or masticatory muscles. This article aims to provide a tool for diving physicians or medical professionals involved in diving medicine since jaw pain among divers is a pertinent subject and can be challenging to evaluate without some background in dentistry or maxillofacial surgery. Method: A basic algorithm was developed to provide a tool to differentiate jaw pains experienced by divers. Three brief case studies were developed, and five diving physicians were tasked with diagnosing the cases using the algorithm. Additionally, simple exercises and massage techniques that can benefit patients with TMD, particularly immediately after diving, are outlined. Results: All five diving physicians successfully diagnosed the cases using the algorithm. However, three of them were unable to diagnose the first case (disc luxation) without consulting the algorithm. Nevertheless, all physicians acknowledged the utility of the algorithm. Conclusions: Jaw pain in divers can stem from diverse causes, but effective treatment options exist. Our study findings provide valuable insights to assist diving physicians in making accurate diagnoses and guiding appropriate patient management, which may include referrals to specialists such as dentists, maxillofacial surgeons, or orthodontists.

Genetically predicted major depression causally increases the risk of temporomandibular joint disorders

Objective

Observational studies have reported that mental disorders are comorbid with temporomandibular joint disorder (TMD). However, the causal relationship remains uncertain. To clarify the causal relationship between three common mental illnesses and TMD, we conduct this Mendelian Randomization (MR) study.

Methods

The large-scale genome-wide association studies data of major depression, bipolar disorder and schizophrenia were retrieved from the Psychiatric Genomics Consortium. The summary data of TMD was obtained from the Finn-Gen consortium, including 211,023 subjects of European descent (5,668 cases and 205,355 controls). The main approach utilized was inverse variance weighting (IVW) to evaluate the causal association between the three mental disorders and TMD. Five sensitivity analyses including MR-Egger, Maximum Likelihood, Weighted median, MR. RAPS and MR-PRESSO were used as supplements. We conducted heterogeneity tests and pleiotropic tests to ensure the robustness.

Results

As shown by the IVW method, genetically determined major depression was associated with a 1.65-fold risk of TMD (95% CI = 1.10-2.47, p < 0.05). The direction and effect size remained consistent with sensitivity analyses. The odds ratios (ORs) were 1.51 (95% CI = 0.24-9.41, p > 0.05) for MR-Egger, 1.60 (95% CI = 0.98-2.61, p > 0.05) for Weighted median, 1.68 (95% CI = 1.19-2.38, p < 0.05) for Maximum likelihood, 1.56 (95% CI = 1.05-2.33, p < 0.05) for MR. RAPS, and 1.65 (95% CI = 1.10-2.47, p < 0.05) for MR-PRESSO, respectively. No pleiotropy was observed (both P for MR-Egger intercept and Global test >0.05). In addition, the IVW method identified no significant correlation between bipolar disorder, schizophrenia and TMD.

Conclusion

Genetic evidence supports a causal relationship between major depression and TMD, instead of bipolar disorder and schizophrenia. These findings emphasize the importance of assessing a patient's depressive status in clinical settings.

Psychological distress and well-being: their association with temporomandibular disorder symptoms

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.

Assessment of self-rated pain perception and whole salivary cortisol levels among adolescents with and without temporomandibular disorders

OBJECTIVE

To assess the self-perceived pain perception (PP) and whole salivary cortisol levels (CL) among adolescents with and without temporomandibular disorders (TMD).

METHODS

Adolescents between 15 and 17 years were included. Participants were categorized into three groups: Group 1: patients with TMD; Group 2: nocturnalbruxers without TMD; and Group 3: controls. Demographic data CL and self-rated PP were assessed. A p-value < 0.05 was proposed as statistically significant.

RESULTS

Fifty-four patients (18 per group) were included. Scores of self-rated PP in the affected TMJ were higher in Group 1 than Group 2 (p < 0.001). Whole salivary CL were higher in groups 1 and 2 (p < 0.01) than in Group 3. Whole salivary CL were higher in Group 2 than Group 3 (p < 0.05).

CONCLUSION

Whole salivary CL are higher in adolescents with TMD, and there is a direct relationship between self-rated PP in the TMJ area and salivary CL.

Causal relationship between psychiatric traits and temporomandibular disorders: a bidirectional two-sample Mendelian randomization study

OBJECTIVES

This study was to investigate the causal relationship between temporomandibular disorders (TMD) and psychiatric disorders by Mendelian randomization (MR) analysis.

MATERIALS AND METHODS

A two-sample bidirectional MR analysis was adopted to systematically explore the causal relationship between TMD and eight psychiatric traits, including anxiety disorder (AD), panic disorder (PD), major depressive disorder (MDD), neuroticism, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BIP), and schizophrenia (SCZ). Inverse variance weighted (IVW), weighted median, and MR-Egger regression were used in my study. Furthermore, we also performed three sensitivity analyses to illustrate the reliability of the analysis.

RESULTS

Two psychiatric traits have risk effects on TMD: PD (OR = 1.118, 95% CI: 1.047-1.194, P = 8.161 × 10-4, MDD (OR = 1.961, 95% CI: 1.450-2.653, P = 1.230 × 10-5). Despite not surpassing the strict Bonferroni correction applied (P > 0.00625), we could think that there was a suggestive causal effect of neuroticism and SCZ increasing the risk of TMD. On the reverse MR analysis, we found no significant evidence of causal effects of TMD on these psychiatric traits. Except for heterogeneity in the causal analysis for SCZ on TMD, no heterogeneity and horizontal pleiotropy were detected in the other analyses.

CONCLUSIONS

Our two-sample MR study has provided further evidence of PD and MDD being related to a higher risk of TMD.

CLINICAL RELEVANCE

These findings highlight the importance of closely monitoring mental traits during future TMD treatments to prevent an increased risk of TMD.

Prevalence of temporomandibular disorders in the Brazilian population: A systematic review and meta-analysis

This systematic review aimed to assess the prevalence of temporomandibular disorders (TMD) in the Brazilian population, with studies that used the RDC/TMD or DC/TMD as diagnostic tools. A total of 6365 people from 11 studies were included. Sample mean age ranged from 12 to 69.5 years. The pooled prevalence of TMD was 33.6% (95% CI 31.5-35.8; I2 = 37.2). Prevalence of TMD was higher in females (37.0%) than in males (29.3%). Our results indicate that TMD is a prevalent condition across Brazil's territories. The results from this meta-analysis can help calculate more accurate sample sizes for future studies.

Association of stress, anxiety, and depression levels with sleep quality in patients with temporomandibular disorders

OBJECTIVE

To examine the psychological symptoms of TMD and their effects on sleep quality in patients with temporomandibular disorders.

METHODS

The study was carried out with 425 consecutive TMD patients who sought care at the oral and maxillofacial surgery clinic of a faculty of dentistry. Perceived Stress Scale-14, Beck Anxiety Scale, and Beck Depression Scale were used to evaluate the psychological state. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index.

RESULTS

The mean sleep score of all participants was 6.52. As the level of anxiety and depression increased, the scores of both total sleep quality and sleep quality components increased significantly p < 0.01. On the other hand, those with poor sleep quality had significantly higher stress, anxiety, and depression levels than those with good sleep quality p < 0.01.

CONCLUSION

Negative emotional situations such as stress, anxiety, and depression seriously impair sleep quality in TMD patients.

Determination of pain intensity, pain-related disability, anxiety, depression, and perceived stress in Polish adults with temporomandibular disorders: A prospective cohort study

BACKGROUND

There is a need to assess a relationship between the psychoemotional state of patients and the occurrence and the intensity of pain and temporomandibular disorders (TMD) in relation to a Polish population. There are no such precision data in the literature relating to the population of big Eastern European country. The study conducted by the authors refer to a large group of male and female adult patients of the Polish population in a different age profile. As a result, this study provides a picture of the situation that also takes into account population characteristics that may affect the clinical situation of patients.

OBJECTIVE

The aim of the study was to assess the pain intensity, pain-related disability, anxiety, depression, and perceived stress among Polish adults with TMD as well as the association between psychosocial impairment and TMD.

MATERIALS AND METHODS

This prospective cohort study included 219 adult patients from the Outpatient Clinic for Temporomandibular Disorders at the Academic Dental Polyclinic in Wroclaw. The patients completed validated questionnaires, and received a TMD diagnosis based on a standardized examination (Diagnostic Criteria for Temporomandibular Disorders) performed by a qualified dentist. A statistical analysis was carried out on the collected data.

RESULTS

Myalgia was the most commonly diagnosed condition among the TMD patients. Furthermore, the prevalence of perceived stress, anxiety, and depression was high in the studied sample. Females showed more depression symptoms than males, while the level of anxiety and stress was similar in both groups. The most statistically significant correlation was observed between the group of masticatory muscle disorders and the level of depression, stress, pain intensity, and pain-related disability.

CONCLUSION

Due to the high prevalence of increased levels of anxiety, depression, and perceived stress, it is essential to screen the psychosocial status of Polish TMD adult patients. Psychosocial status may have an impact on a studied patient's response to treatment and pain intensity, and pain-related disability. Therefore, Polish TMD adult patients should be provided with management based on an interdisciplinary approach.

CLINICAL TRIAL REGISTRATION

[https://clinicaltrials.gov/], identifier [NCT05183503].

Temporomandibular joints disorders (TMDs) prevalence and their relation to anxiety in dental students

Background: Temporomandibular joint disorders (TMDs) are very common disorders affecting the population and causing pain. Researchers have reported a high prevalence of TMDs among university students due to increased distress. The aims of this study were to determine the frequency of TMDs in Umm al-Qura University (UQU) dental students using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and to examine the relationship between anxiety, bruxism, and TMDs among those students. Methods: The DC/TMD pain screener questionnaire was completed by dental students. Students who reported TMD pain or had at least one positive TMD symptom were invited to the dental clinic for a full TMJ evaluation. History of bruxism was documented and an ultra-brief tool for detecting anxiety and depression (Patient Health Questionnaire-4 PHQ) was completed by all students. Results: A total of 240 students responded to the TMD pain screener in which 119 reported at least one TMJ symptom. Only 93 dental students presented to clinical examination in which 64.5% (n=60) of them had temporomandibular joint disorders. Disc displacement with reduction and local myalgia (38.7% & 32.25%, respectively) were the most frequent diagnosis. A total of 29% (n=27) of students had more than one diagnosis. Overall, 41 participants (44.09%) reported a positive response to the anxiety scale and (n=38) 40% of participants reported parafunctional habits. Both the history of bruxism and anxiety were significantly related to TMDs (P=0.0002) and also significantly higher in women of higher academic years (P≤0.01). Conclusions: This study found a high prevalence of TMDs among UQU dental students. Disc displacement with reduction was the most prevalent disorder. Bruxism and anxiety were associated with painful TMDs.

Association between temporomandibular disorders and anxiety: A systematic review

Temporomandibular Joint Dysfunction (TMD) is an umbrella term that includes musculoskeletal and neuromuscular conditions affecting the temporomandibular joint. The present systematic review aimed to verify whether there is a specific association between TMD and anxiety. The searches were carried out in electronic databases, including PubMed, Scopus, Web of Science, and LILACS, without restrictions on publication date and language. The acronym PECO was used, whose participants (P) were humans exposed to TMD (E), compared to participants without TMD (C) and the presence of anxiety as an outcome (O). After the search retrieval, the duplicates were removed, and the articles were evaluated by title and abstract, following our inclusion and exclusion criteria; then, the papers were read and thoroughly assessed. After selection, the methodological quality was performed using the Newcastle-Ottawa Scale (NOS) for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the level of evidence. A total of 710 studies were found, and 33 articles were considered eligible and were included for the qualitative synthesis and the level of evidence assessment. The studies confirmed the association between anxiety and DTM, although there was a low certainty of evidence among the selected studies. Most articles showed a low risk of bias. Although the limitations of this systematic review, it suggested a significant association between anxiety and TMD, as well as highlights possible directions for future research.

Anxiety Assessment in Orofacial Pain Patients

Objectives The aim of the present study was to assess the anxiety level in patients with orofacial pain and to compare it with patients without any orofacial pain.

Materials and Methods The survey-based study was conducted that included a total of 100 patients who were divided into two groups: 50 patients with orofacial pain and 50 patients without pain. Questionnaire in a local language, that is, Marathi, was formulated based on Modified Dental Anxiety Scale (MDAS) and Hospital Anxiety and Depression Scale (HADS). Data was then subsequently collected and evaluated according to the score of MDAS and HADS.

Results A total of 78 patients were evaluated according to the questionnaire survey. Highly significant correlation was found between anxiety level and pain present in patient on the MDAS-anxiety level scale(p = 0.001). Also, a significant correlation was observed between anxiety level and pain present in patient on the HADS-anxiety level (p = 0.007). A significant correlation was found between gender and pain anxiety level in patients on the MDAS-anxiety level (p = 0.009).

Conclusion Anxiety level in patients with orofacial pain can be assessed with MDAS and HADS. Specific types of anxiety-related concerns definitely occur at higher levels in orofacial pain patients in comparison to patients without pain. Greater attention needs to be employed on understanding of anxiety level in orofacial pain patients. This is detrimental in acceptance of treatment by patient and ultimately affects outcome. Anxiety level assessment helps in better understanding of apprehension among the patients with orofacial pain, and enables better delivery of appropriate care and intervention.

[On the role of psychological disorders in the development of the syndrome of pain dysfunction of the temporomandibular joint]

There are significant disagreements related to the understanding of the etiopathogenesis of the syndrome of pain dysfunction of the temporomandibular joint. This review article examines the role of patient's psychological status as a significant factor influencing the occurrence and complications of this pathology, as evidenced by an increase in stress, anxiety, and depression in patients with the dysfunction. The need for a multidisciplinary and individual approach to the diagnosis and treatment is also discussed, which can significantly alleviate the severity of the disease, reduce complications, and shorten the rehabilitation time.

Efficacy of different combinations of physiotherapy techniques compared to exercise and patient education in temporomandibular disorders: A randomized controlled study

OBJECTIVE

This study aims to investigate the efficacy of different types of physiotherapy approaches in individuals with cervical myofascial painful temporomandibular disorders (TMDs).

METHODS

Seventy-five participants with myofascial pain of jaw muscles and cervical myofascial pain were randomized into three groups: exercise group (E), low-level laser therapy group (LLLT), and manual pressure release group (MPR). All patients were assessed before treatment and after 12 sessions of treatment.

RESULTS

Significant improvement was seen in all groups' pressure pain threshold (PPT) values (p < 0.01). Some masticatory and neck muscles' PPT changes in MRP and LLLT groups were significantly higher than the exercise group (p < 0.05).

CONCLUSION

Exercise therapy is an effective approach for treatment of TMDs. Additionally, LLLT combined with exercise and MPR combined with exercise have better effects than only exercise therapy. Multimodal treatment approaches should include exercise to achieve better results in clinical practice.

Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis

BACKGROUND

Because of various clinical manifestations and complicated courses, temporomandibular disorders (TMDs) are difficult to treat. Current knowledge about this disease remains insufficient for precise treatment after diagnosis.

OBJECTIVES

The objective of this study is to obtain and map the overall literature trends and most cited keywords in TMDs research.

METHODS

Many indicators, including annual number of publications, country distribution, global cooperations, author contributions, original journals, cited references and keywords, were calculated and evaluated using VOSviewer v.1.6.13, which visualised many results, from the WoSCC database.

RESULTS

A total of 3121 papers on TMDs research were retrieved from 2010 to 2019. The United States produced the most articles published, but the most productive institution was the University of Sao Paulo (Brazil). Researchers and institutions conducting TMDs research have shown a very widespread and close connection. TMDs have been studied worldwide by many research centres. Professor Svensson P was the most published researcher in TMDs research and the Journal of Oral Rehabilitation published the most TMDs research articles. The top cited references mainly presented diagnostic criteria of TMDs. The most cited keywords formed clusters: (a) Anatomical factor of TMDs, (b) Symptoms of TMDs and (c) RDC/TMD, the risk factors, biopsychosocial factors and epidemiology of TMDs.

CONCLUSIONS

The research results provide very valuable data for a thorough understanding of the research status of TMDs and demonstrated international cooperation.

Coronavirus Lockdown as a Major Life Stressor: Does It Affect TMD Symptoms?

Temporomandibular disorders are multi-factorial conditions that are caused by both physical and psychological factors. It has been well established that stress triggers or worsens TMDs. This paper looks to present early research, still unfolding, on the relationship between COVID-19 as a major life stressor and TMDs. The main aims of this study were to: investigate the presence of symptoms related to TMDs and the time of onset and the worsening of painful symptoms in relation to the changes in social life imposed by the coronavirus pandemic; and to evaluate the perception of COVID-19 as a major stressful event in subjects who report worsening of painful TMD symptoms. One hundred and eighty-two subjects answered questionnaires—Axis II of the RDC/TMD, the PSS, and specific items about coronavirus as a stressful event—during the lockdown period for COVID-19 in Italy to evaluate the presence of reported symptoms of TMD and the level of depression, somatization, and stress perceived. The results showed that 40.7% of subjects complained about TMD symptoms in the past month. Regarding the time of onset, 60.8% of them reported that facial pain started in the last three months, while 51.4% of these subjects reported that their symptoms worsened in the last month and were related to the aggravation of pain due to the coronavirus lockdown as a major life event and to the stress experienced. The results of this study seem to support the hypothesis that stress during the pandemic lockdown influenced the onset of temporomandibular joint disorders and facial pain, albeit with individual responses.

Women’s oral health-related quality of life as a risk factor for TMD symptoms. A case-control study

OBJECTIVE

To investigate the association between temporomandibular disorder (TMD) symptoms and women's oral health-related quality of life (OHRQoL).Methods: An observational case-control study was performed with 765 adult women aged 21.5 years on average. Oral Health Impact Profile (OHIP-14) assessed OHRQoL and determined the selection of cases and controls matched by age and marital status at a ratio of 1:4 (153 cases: 612 controls). American Academy of Orofacial Pain's self-explanatory questionnaire assessed the TMD symptoms. The TMD symptoms' impact on OHRQoL was analyzed, estimating the odds ratio with a 95% confidence interval.

RESULTS

Of the women, 86.9% in the case group, and 69.6% in the control group presented some TMD symptoms (p< 0.05). Women with an impacted OHRQoL are 2.95 (95% CI:1.79-4.86) times more likely to report some TMD symptoms (p< 0.05).

DISCUSSION

Women with a negative impact on OHRQoL are more likely to report TMD symptoms.

Rates of Physician Coprescribing of Opioids and Benzodiazepines After the Release of the Centers for Disease Control and Prevention Guidelines in 2016

IMPORTANCE

The Centers for Disease Control and Prevention guidelines in 2016 recommended avoiding concurrent use of opioids and benzodiazepines.

OBJECTIVE

To determine whether the release of the guidelines was associated with changes in coprescription of opioids and benzodiazepines.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study used claims data obtained from a US national database of medical and pharmacy claims for 3 598 322 adult commercially insured patients and 1 299 142 Medicare Advantage (MA) beneficiaries with no recent history of cancer, sickle cell disease, or hospice care who ever used prescribed opioids during the study period, January 1, 2014, through March 31, 2018.

EXPOSURES

Overlapping opioid and benzodiazepine prescriptions filled.

MAIN OUTCOMES AND MEASURES

The extent (proportion of person-months with any overlapping days of prescription of opioids and benzodiazepines) and intensity (proportion of days with opioids prescribed where benzodiazepines were also available) of coprescription.

RESULTS

Of 4 897 464 patients (with 13.4 million person-months of opioid use), the total number of unique commercially insured individuals was 3 598 322 (1 974 731 women [54.9%]), and the total number of unique MA beneficiaries was 1 299 142 (770 256 women [59.3%]). Among 128 576 participants experiencing chronic pain episodes, more than one-half of person-months of long-term opioid use occurred in women (52.7% of person-months among those with commercial insurance and 62.4% of person-months among MA beneficiaries). The median (interquartile range) age of the participants was 51 (41-58) years for patients in the commercial insurance group and 70 (61-77) years for those in the MA group. The mean (SE) extent of coprescription was 23.0% (0.18%) for the commercial insurance group and 25.7% (0.18%) for the MA group. The extent of coprescription decreased in the targeted guideline population-individuals with long-term opioid use-after the guideline release (postguideline slope, -0.95 percentages point per year [95% CI, -1.44 to -0.46 percentage points per year] for the commercial insurance group and -1.06 percentage points per year [95% CI, -1.49 to -0.63 percentage points per year] for the MA group). Nontargeted short-term episodes of opioid use were associated with no change or small declines in trend (for the MA group, postguideline slope of 0.47 percentage point per year [95% CI, 0.35-0.59 percentage point per year]; for the commercial insurance group, postguideline slope of -0.05 percentage point per year [95% CI, -0.12 to 0.02 percentage point per year]). High coprescribing intensity was seen, with 79.3% (95% CI, 78.9%-79.6%) of opioid prescription days in the commercial insurance group and 83.9% (95% CI, 83.7%-84.2%) in the MA group overlapping with benzodiazepines. There was no change in the intensity of coprescribing. Intensity of coprescription was higher when the same clinician prescribed opioids and benzodiazepines.

CONCLUSION AND RELEVANCE

This study observed a reduction in the extent but not intensity of coprescribing of benzodiazepines for patients with long-term opioid use.

Prevalence of Temporomandibular Disorder in Turkish University Students: a Questionnaire Study

Background/Aim: Temporomandibular dysfunction (TMD) might influence any individual with different signs and symptoms irrespective of gender or age. The aim of this study is to assess the prevalence of TMD in Oral and Dental Health Program students of İstanbul University-Cerrahpaşa.

Material and Methods: This study include a sample of 486 students with age ranging from18 to 24 years. The presence and severity of TMD was evaluated using the Fonseca’s Anamnestic Index (FAI) and its questionnaire. The data were analysed using SPSS Version 22. The chisquare test was used to compare the data from different groups and to determine whether the differences were statistically significant.

Results: The results showed that a total of 47,53% of students had some degree of TMD and females were generally more affected than males. These degrees were as follows: 33,95 % were classified as mild, 11,52 % moderate and 2,05 % severe signs and symptoms. The women exhibited some degree of TMD (51,8%) at a higher frequency than men (40,33%). No significant differences were observed between gender for a same TMD severity degree (p>0.05).

Conclusions: A high prevalence of mild TMD was found in this study population. In addition, tense personalities, headaches, and temporomandibular joint (TMJ) sounds were the most prevalent findings of TMD. The present study suggests that Fonseca’s Anamnestic Index (FAI) has been used in screening for TMD for prevention and management of TMD in a non-patient young population.

Síndrome da disfunção da articulação temporomandibular e o estresse presente no trabalho policial: revisão integrativa

Resumo O estudo objetivou investigar se o estresse presente nas atividades dos trabalhadores da polícia brasileira pode ter relação com o desenvolvimento da síndrome da disfunção da articulação temporomandibular (DTM), uma doença comumente associada a condições estressantes. Realizou-se uma revisão integrativa de literatura sobre os temas estresse, DTM e atividade policial. Foram identificadas diversas fontes estressoras no trabalho do policial brasileiro e observou-se que o estresse influencia no desenvolvimento, agravamento e tratamento dos sintomas da síndrome. Há comprometimento na qualidade de vida e saúde dos portadores de DTM. O fato de estudos terem mostrado associação entre estresse e atividades desenvolvidas pelos policiais brasileiros, bem como relação entre estresse e DTM, levou à suposição de que é possível haver relação entre o estresse gerado pelo trabalho executado por policiais e o risco de desenvolvimento da DTM por essa classe de trabalhadores. É recomendado que o indivíduo portador da síndrome seja avaliado como um todo antes da execução do tratamento e que esse tratamento seja multidisciplinar. A literatura sobre DTM em policiais ainda é incipiente, motivo pelo qual sugere-se o desenvolvimento de estudos sobre o tema.

A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students

OBJECTIVE

Dental students have been identified as a group with high risks of developing both temporomandibular disorders (TMD) and psychosocial conditions. Our primary aim was to evaluate the cross-sectional prevalence of TMD diagnoses, as defined in the Diagnostic Criteria (DC)/TMD, among dental students. The secondary aim was to evaluate the prevalence and association of behavioural and psychosocial factors in relation to DC/TMD diagnoses.

MATERIALS AND METHODS

The study was conducted among undergraduate dental students during the second semester of their third year at the Department of Odontology, Medical Faculty, Umeå University, Sweden. Three consecutive cohorts were recruited during August in 2013, 2014, 2015. In total, 54 students were included and examined according the DC/TMD procedure.

RESULTS AND CONCLUSIONS

The prevalence of any DC/TMD diagnosis was 30%. The most prevalent TMD diagnosis was myalgia. Individuals with a TMD-pain diagnosis (i.e. myalgia or arthralgia) reported significantly higher pain intensity levels according to the Graded Chronic Pain Scale (GCPS) as compared to individuals without TMD-pain (Fisher's exact test p < .001, two-sided). In addition, individuals with any TMD scored significantly higher jaw functional limitations according to the Jaw Functional Limitation Scale 20 (JFLS-20, p < .001) and oral parafunctions according to the Oral Behavior Checklist (OBC, p = .005) as compared to individuals without TMD. The psychosocial factors evaluated did not differ between individual with or without a TMD diagnosis. The majority of the dental students reported symptoms that are already identified as risk factors for developing TMD and pain conditions. However, longitudinal data are needed to evaluate how this evolves over time.

Pain threshold, sleep quality and anxiety levels in individuals with temporomandibular disorders

ABSTRACT Purpose: to evaluate the pressure pain threshold, sleep quality and anxiety levels of individuals with different types of chronic temporomandibular disorders (TMD). Methods: a controlled, observational and cross-sectional study. TMD diagnosis followed the Research Diagnostic Criteria and the volunteers were divided into three groups: A-Muscular Disorder (n = 15), B- Articular Disorder (n = 10) and C- Control Group (n = 15). Evaluation was performed using the Pittsburg Sleep Quality Index, Visual Analog Scale, Algometry and Hospital Anxiety and Depression Scale. The significance level for all tests was 5%. Results: lower threshold of pain was seen in the masticatory and cervical musculature within groups A and B. However, when TMD groups were compared to the control group, only a statistically significant difference in the pain threshold of the masticatory muscle and the trapezius muscle was found. Groups A and B presented poor sleep quality, showing a statistical difference when compared to the control group. Additionally, it was observed that patients in the groups with TMD presented anxiety, while those in the control group, did not present it. Conclusion: individuals presented with TMD show lower levels of pain threshold, sleep quality and anxiety, as compared to healthy subjects. These results do not depend on the type of disorder presented.

Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life

The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

Association of temporomandibular disorder and high frequency of suicide ideation in Korean adolescents: a cross-sectional survey

BACKGROUND

This study investigated the association between psychological factors and temporomandibular disorder (TMD) in a representative sample using data from the Korean nationwide survey.

METHODS

The study included 1337 adolescents. Participants provided demographic, socio-economic and behavioural information, and responses to questionnaires assessing their mental health status including perceived stress, depressed mood and suicidal ideation in the presence of TMD. In univariate analysis, t-test was used to test the association between TMD and risk factors by gender in a complex sampling design. Multivariate logistic regression analyses were used to examine the association between TMD and psychological factors.

RESULTS

Male adolescents with TMD were highly engaged with depressed mood and suicidal ideation (p = .0006, p = .0223), however, no psychological factors were significant in female adolescents (p < .05). Male adolescents with both depressed mood and suicidal ideation had significantly high rates of TMD (p = .0024). The risks for experiencing depressed mood (OR: 3.07) and suicidal ideation (OR: 2.564) were significantly associated with TMD in male adolescents after adjusting confounders.

CONCLUSIONS

The results provide evidence that the depressed mood and suicidal ideation were associated with TMD in male adolescents. This study has important implications for enhanced screening and evaluation of mental health among patients with TMD according to gender.

Prevalence of temporomandibular disorders among a cohort of university undergraduates in Australia

AIM

The aim of the present study was to determine the prevalence of temporomandibular disorder (TMD) symptoms among dentistry students at James Cook University in Australia, and to determine the associations of TMD symptoms with demographic parameters and compare the prevalence to that of the Australian general population.

METHODS

The study was conducted at the School of Dentistry, James Cook University. Axis I symptom questionnaire of diagnostic criteria for TMD was used to assess the prevalence of TMD symptoms. Additional questions were included to gather demographic information on the participants. Data were collected anonymously via the online survey tool, SurveyMonkey.

RESULTS

The overall prevalence of TMD symptoms in this cohort was 77.2%. The most common TMD symptoms were pain (48.5%) and joint noises (48.5%). Females reported a significantly higher prevalence of TMD symptoms than males, with 73 of 88 female respondents (83%) and 32 of 48 male respondents (66.7%) reporting at least one symptom of TMD (P = .030).

CONCLUSIONS

The overall prevalence of TMD symptoms in the population studied was 77.2%, with female preponderance of TMD symptoms (83%). This is higher than the estimated prevalence (23%) in the Australian general population.

Correlation between oral health-related quality of life and clinical dysfunction index in patients with temporomandibular joint osteoarthritis

We evaluated the correlation between oral health-related quality of life (OHRQoL) and the Helkimo clinical dysfunction index (HDI) in patients with temporomandibular joint osteoarthritis (TMJ OA). Clinical data and scores for the Chinese version of the 14-item Oral Health Impact Profile (OHIP-C14) were recorded and analyzed for 541 patients with TMJ OA. Each patient was assigned an HDI score of 1 to 25, which was used to classify severity into three categories. OHRQoL was assessed by using OHIP-C14 score, which ranged from 0 to 56. Both HDI score and severity were significantly correlated with total OHIP-C14 score (P < 0.001 for both comparisons). The scores for all HDI domains except function impairment (P = 0.205) were significantly correlated with OHIP-C14 score. The scores for all seven OHIP-C14 domains were significantly correlated with HDI score and severity. Several correlations between OHIP-C14 domains and HDI domain scores were significant. HDI score and severity were correlated with OHIP-C14 score in TMJ OA patients. As compared with function-related domains, pain-related HDI domains were more strongly inversely related to OHRQoL.(J Oral Sci 58, 483-490, 2016).

Frequency of Symptoms of Temporomandibular Disorders among Prishtina Dental Students

BACKGROUND

Early diagnosis of temporomandibular disorders (TMD) is important for prevention of greater damages of the parts of the oro-facial system. There are early symptoms that can be used as predictors of TMD.

AIM

The study aimed to assess the frequency of the symptoms of TMD among dental students.

METHODS

Total number of 166 respondents, all undergraduate dental students, (84 female, 82 male), mean age 22, participated in this study. For the study, the questionnaire of Fonseca was used. There were ten questions to answer with: no, sometimes and yes. Fonseca-Clinical index classification is: 0-15 points, no TMD; 20-40 points, mild TMD; 45-65 points, moderate TMD and 70-100 points, severe TMD.

RESULTS

Forty-six point four percentages of the students, had no symptoms of TMD, 44.6 % had mild TMD, 7.8% moderate TMD and only 1.2 % had severe TMD. By conventional criteria, there is not any statistical difference of the TMD between male and female (χ² = 1.133, p = 0.769).

CONCLUSION

Fonseca questionnaire has its importance in the early diagnosis of TMD that can occur in the young population.

Relationship between anxiety and temporomandibular disorders in dental students

OBJECTIVE

To evaluate the prevalence of temporomandibular disorder (TMD) in dental students and its correlation with anxiety.

METHODS

After probability sampling, 105 students were selected. The diagnosis of TMD was carried out using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I; the anxiety level was obtained by the State-Trait Anxiety Inventory (STAI). Data from TMD and anxiety were calculated through frequency and Chi-square test to assess the association between TMD and anxiety, considering a significance level of 5%.

RESULTS

TMD was present in 36.2% of the students; disc displacement (42.1%), and arthralgia (42.1%) were the most prevalent subtypes. The majority of students presented both traits (57.1%) and state (65.7%) anxiety in mild levels, followed by moderate levels. No statistical association between TMD and anxiety was found (p > 0.05).

CONCLUSION

Joint TMD was the most prevalent subtype of TMD in dental students and was not associated with anxiety levels.

Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment

Chronic pain and mental health disorders are common in the general population, and epidemiological studies suggest that a bidirectional relationship exists between these 2 conditions. The observations from functional imaging studies suggest that this bidirectional relationship is due in part to shared neural mechanisms. In addition to depression, anxiety, and substance use disorders, individuals with chronic pain are at risk of other mental health problems including suicide and cigarette smoking and many have sustained sexual violence. Within the broader biopsychosocial model of pain, the fear-avoidance model explains how behavioral factors affect the temporal course of chronic pain and provides the framework for an array of efficacious behavioral interventions including cognitive-behavioral therapy, acceptance-based therapies, and multidisciplinary pain rehabilitation. Concomitant pain and mental health disorders often complicate pharmacological management, but several drug classes, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and anticonvulsants, have efficacy for both conditions and should be considered first-line treatment agents.

Role of Auriculotherapy in the Treatment of Temporomandibular Disorders with Anxiety in University Students

Introduction. The aim of this study was to evaluate the role of auriculotherapy with mustard seeds in the treatment of temporomandibular disorders (TMDs), anxiety, and electromyographic (EMG) activity in university students. Methodology. The State Trait Anxiety Inventory (STAI), Research Diagnostic Criteria (RDC) for TMDs (RDC/TMDs), and electromyography were used in this study of 44 college students with high levels of anxiety and TMDs. The subjects were divided into two groups: an auriculotherapy (AA) group (n = 31) and an AA sham group (n = 13). The mustard seeds were applied to the shenmen, rim, sympathetic, brain stem, and temporomandibular joint (TMJ) points in the AA group and to sham points in the external ear and wrist in the AA sham group. The treatment protocol was 10 sessions (two treatments per week). Results. Anxiety (p < 0.01) was significantly reduced in the AA group. This group also showed a decrease in tender points in the mandibular posterior region (p = 0.04) and in the right side of the submandibular region (p = 0.02). Complaints of bilateral pain were reduced in the temporal tendon (p ≤ 0.01) and in the left side of the ATM (p < 0.01). In addition, electromyographic (EMG) activity was reduced during temporal muscle contraction (p = 0.03).  Conclusion. Auriculotherapy was effective in the treatment of students with anxiety and TMDs.

Disfunção Temporomandibular segundo o Nível de Ansiedade em Adolescentes

RESUMOO objetivo do estudo foi determinar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM), segundo o nível de ansiedade de adolescentes da cidade de São Roque-SP. Foi utilizado o Índice de Fonseca para determinar a presença e o grau de severidade da DTM. Para avaliar o nível de ansiedade, foi utilizado o Inventário de Ansiedade Traço-Estado. Os participantes foram 3538 adolescentes entre 10 e 19 anos. Os resultados revelaram que 73,3% dos adolescentes apresentavam DTM e 72,7%, apresentavam ansiedade. Foram observadas associações estatisticamente significativas entre a presença de DTM e a presença de ansiedade, mas apenas com o sexo feminino, e correlação positiva, embora baixa, entre o grau de DTM e o nível de ansiedade. Conclui-se que adolescentes do sexo feminino apresentam maior chance de desenvolver DTM que os do sexo masculino, e quanto maior o nível de ansiedade do adolescente, maior a chance de desenvolver DTM.

Chronicity factors of temporomandibular disorders: a critical review of the literature

Facial pain often persists long after any identifiable organic pathology has healed. Moreover, in a subgroup of patients with temporomandibular disorder (TMD), no treatment is effective. Knowledge of factors associated with persistent pain in TMD could help identify personalized treatment approaches. Therefore, we conducted a critical review of the literature for the period from January 2000 to December 2013 to identify factors related to TMD development and persistence. The literature findings showed that chronic TMD is marked by psychological distress (somatization and depression, affective distress, fear of pain, fear of movement, and catastrophizing) and characteristics of pain amplification (hyperalgesia and allodynia). Furthermore, these factors seem to interact in TMD development. In addition, our review demonstrates that upregulation of the serotonergic pathway, sleep problems, and gene polymorphisms influence the chronicity of TMD. We conclude that psychological distress and pain amplification contribute to chronic TMD development, and that interactions among these factors complicate pain management. These findings emphasize the importance of multidisciplinary assistance in TMD treatment.

Temporomandibular Disorders in a Sample Population of the Brazilian Northeast

Temporomandibular disorder (TMD) is a common condition. This study is part of a research group and it investigated the prevalence of TMD and myofascial pain and its association with gender, age and socioeconomic class. The sample comprised 100 subjects, aged 15 to 70, users of the Family Health Units' services, in the city of Recife, PE, Brazil. The TMD degree was evaluated using the Research Diagnostic Criteria for TMD and socioeconomic class by the Economic Classification Criteria Brazil. Categorical variables were analyzed by chi-square test for proportions and Fisher's exact test for 2x2 tables, and binary logistic analysis to track the relationship between the independent and dependent variables. According to the results, 42% of the subjects had TMD and 14% myofascial pain. No statistically significant association could be found between TMD and gender or socioeconomic class, but it was found to have statistically significant association with age, and myofascial pain was associated with socioeconomic class. Considering that the results of the present study should be confirmed by further studies and the fact that this was a pilot study, the prevalence must be analyzed with caution.

Is there an association between anxiety/depression and temporomandibular disorders in college students?

Objective

Considering the high incidence of Temporomandibular Disorders (TMD) in the population aged 15-30 years and the fact that students are exposed to stressful psychosocial factors, the purposes of this study were: to verify clinical symptoms and jaw functionality in college students with TMD according to the anxiety/depression (A/D) level and to evaluate the correlation between A/D and functionality, maximum mouth opening (MMO) and pain and muscle activity.

Material and Methods

Nineteen students with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent two assessments during an academic semester. The evaluations were based on questionnaires (MFIQ - Mandibular Function Impairment Questionnaire; HADS - Hospital Anxiety and Depression Scale), clinical measurements (MMO without pain, MMO and assisted MMO; palpation of joint and masticatory muscles), and electromyography. The HADS scores obtained in the two assessments were used to classify all data as either "high" or "low" A/D. Data normality, differences and correlations were tested with the Shapiro-Wilk test, Student's t-test (or the Wilcoxon test), and Spearman test, respectively. The alpha level was set at 0.05.

Results

None of the clinical variables were significantly different when comparing low and high A/D data. In low A/D there was a significant correlation between HADS score and: MFIQ (P=0.005, r=0.61), and MMO without pain (P=0.01, r=-0.55).

Conclusions

Variation in A/D level did not change clinical symptoms or jaw functionality in college students with TMD. Apparently, there is a correlation between TMJ functionality and A/D level, which should be further investigated, taking into account the source of the TMD and including subjects with greater functional limitation.

Quality of life and general health in patients with temporomandibular disorders

The aim of this study was to associate minor psychiatric disorders (general health) and quality of life with temporomandibular disorders (TMD) in patients diagnosed with different TMD classifications and subclassifications with varying levels of severity. Among 150 patients reporting TMD symptoms, 43 were included in the present study. Fonseca's anamnestic index was used for initial screening while axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) was used for TMD diagnosis (muscle-related, joint-related or muscle and joint-related). Minor psychiatric disorders were evaluated through the General Health Questionnaire (GHQ) and quality of life was assessed using the World Health Organization Quality Of Life-Brief Version (WHOQOL-BREF). An association was found between minor psychiatric disorders and TMD severity, except for stress. A stronger association was found with mild TMD. Considering TMD classifications and severity together, only the item "death wish" from the GHQ was related to severe muscle-related TMD (p = 0.049). For quality of life, an association was found between disc displacement with reduction and social domain (p = 0.01). Physical domains were associated with TMD classifications and severity and the association was stronger for muscle and joint-related TMD (p = 0.37) and mild TMD (p = 0.042). It was concluded that patients with TMD require multiple focuses of attention since psychological indicators of general health and quality of life are likely associated with dysfunction.

Análise comparativa entre dois ângulos cervicais com a oclusão em crianças com e sem DTM

OBJETIVO: comparar dois ângulos cervicais com as classificações oclusais em crianças de 6 a 10 anos com e sem Disfunção Temporomandibular (DTM),identificar se há prevalência de DTM quanto ao gênero, e se há influencia da oclusão sobre os ângulos estudados. MÉTODO: realizou-se um estudo observacional transversal com 91 crianças de ambos os gêneros de uma Instituição de Ensino privado, dispostas em Grupo A (sem DTM) e Grupo B (com DTM). Todas as crianças foram avaliadas seguindo uma ficha cadastral constituída de dados referentes a sexo, idade, peso, altura e exame clínico intra-oral para classificação oclusal de Angle. O diagnóstico e a severidade da DTM, foram verificados pelo questionário proposto por Fonseca. Para avaliação dos ângulos cervicais (A1 e A2) foi utilizada a fotogrametria e o Software Alcimagem®. RESULTADOS: entre as crianças avaliadas, 52 (57,14%) apresentaram maloclusão, sendo 29 com DTM e 23 sem DTM, 39 (42,85%) apresentaram normoclusão, sendo 18 sem DTM e 21 com DTM. Quando comparados os ângulos (A1 e A2) a classe oclusal, foi encontrada diferença significante entre as crianças normoclusivas e maloclusivas com o ângulo A1 (p=0,04). CONCLUSÃO: esse estudo demonstrou que o ângulo A1 (C7, ATM e Ápice do Mento) foi estatisticamente significante quando associado com a condição oclusal. Não foi encontrado associação, na população estudada, entre ângulo cervical e DTM. Além disso, também foi possível observar que, a prevalência de crianças do gênero feminino com DTM é significantemente maior que a do gênero masculino. Esse estudo demonstrou que a maloclusão pode alterar somente o ângulo A1 e que a DTM não interfere nos ângulos cervicais estudados.