Relationship between anxiety, quality of life, and sociodemographic characteristics and temporomandibular disorder

Impact of manual therapy on body posture-3-D analysis with rasterstereography - pilotstudy

INTRODUCTION

The relationship between posture and temporomandibular disease (TMD) is unclear. The aim of our study was to determine the influence of manual therapy (MT) on posture in TMD patients compared with healthy subjects.

MATERIAL/METHOD

After consideration of inclusion and exclusion criteria, 30 subjects were included. These were divided into two groups: group A comprised 15 healthy subjects and group B 15 patients with present proven TMD disease. Rasterstereographic images were taken at different times. Group A subjects were scanned twice within half a year and group B before initiation as well as after the first MT and after completion of the prescribed MT. The different posture variables were calculated using DIERS Formetric software.

RESULTS

To illustrate the differences between the two groups, 10 different postural variables were examined. Significant differences between the two groups were observed in pelvic tilt, surface rotation, and kyphotic apex. Pelvic tilt: mean = 7.581, p-value = 0.029; surface rotation: mean = 3.098, p = 0.049; and mean kyphotic apex = 11.538 and 11.946, respectively, with p-values of 0.037 and 0.029, respectively.

CONCLUSION

MT leads to a change in posture in TMD patients. This could influence the course of TMD treatment.

Does anxiety have an impact on temporomandibular disorders? A study in a Turkish sample by using specific questionnaires

OBJECTIVE

The aim of the study is to verify the impact of anxiety on temporomandibular disorders (TMD) by using specific questionnaires in a Turkish sample.

METHODS

This survey was conducted on 292 patients with a mean age of 38.59 ± 10.38 using Helkimo index, Oral Health Impact Profile (OHIP-14), and State Trait Anxiety Inventory (STAI). Spearman Correlation and Fisher Freeman Halton analyses were used for the statistical analysis.

RESULTS

There was no statistically significant difference between the Helkimo anamnestic dysfunction (HAD) levels in terms of OHIP-14 total scores or STAI state scores. There was, however, a statistically positive correlation between STAI state and OHIP-14 total values at 18.4%, a positive correlation between the STAI trait and OHIP-14 total values at 29.8%.

CONCLUSION

No significant correlation was observed between OHIP-14 total scores, STAI state scores, and HAD levels. Therefore, this study did not find a significant relationship between TMDs and anxiety.

Comparison of temporomandibular joint osseous components in unilateral and bilateral cleft lip and palate patients and normal controls: A CBCT study

OBJECTIVE

The objective of this study was to conduct a comparative analysis of the components of the temporomandibular joint in individuals with unilateral, bilateral cleft lip and palate (CLP), and in healthy individuals, utilizing cone beam computed tomography (CBCT) images.

METHOD AND MATERIAL

The present study employed a cross-sectional design and recruited participants aged 18 to 30 years. The participants were categorized into three groups: a control group consisting of 36 individuals without any cleft, a group of 35 patients with unilateral cleft lip and palate (UCLP), and a group of 15 patients with bilateral cleft lip and palate (BCLP). The analysis of CBCT images encompassed the examination of condylar height and angulation, glenoid fossa height and width, articular eminence inclination, as well as joint spaces across all three groups. The Kruskal-Wallis and Mann-Whitney tests were employed to ascertain the significant differences among the three groups.

RESULTS

The UCLP and BCLP groups demonstrated a statistically significant reduction in condylar height and articular eminence inclination in comparison to the control group. Furthermore, a significant difference in the width of the glenoid fossa was seen between the group with clefts and the control group.

CONCLUSION

The CBCT images showed significant differences in several aspects of the temporomandibular joint, including condylar height, articular eminence inclination, and glenoid fossa width, in individuals with cleft palate. These abnormalities can contribute to the development of temporomandibular joint diseases. Therefore, recognizing these distinctions can help prevent further deterioration and progression of temporomandibular disorders (TMD) in CLP patients.

Association between anxiety and temporomandibular dysfunction in adult patients - a systematic review

OBJECTIVE

Anxiety tends to increase muscle tension and painful symptoms; however, its symptoms can be associated with temporomandibular dysfunction (TMD). Therefore, it is crucial for professionals to identify the presence of both comorbidities and determine whether they are related. This study aims to systematically evaluate the literature and answer the question: "Is there an association between anxiety and TMD in adults?"

METHODS

The study followed the PRISMA protocol and was registered in PROSPERO. The custom search was performed in PubMed, Embase, Scopus, and Lilacs databases, as inclusion criteria observational studies that evaluated the association between anxiety and TMD in adults.

RESULTS

A total of 1640 articles were found. After removing duplicates, 988 were evaluated by title and abstract. Of these, 28 were selected for reading in full, of which 13 were included in the present review.

CONCLUSION

The association of anxiety with TMD is positive, except for the minority indicating a low relationship between the disorders, which is explained by neuroscience.

Synthesis of temporomandibular disorders management intervention outcomes for development of core outcome sets: A systematic review

INTRODUCTION

The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies.

AIM

This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS-TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management.

MATERIALS AND METHODS

An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT).

RESULTS

The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD.

CONCLUSIONS

The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.

Quality of life and level of physical activity of individuals with temporomandibular disorders with and without otological symptoms: Secondary analysis of a cross-sectional study

BACKGROUND AND PURPOSE

Otological symptoms (OS) are highly prevalent in individuals with temporomandibular disorders (TMD). Individuals with TMD and OS have more neck disability and decreased deep neck muscles endurance when compared to individuals without OS. However, no studies have evaluated whether OS is associated with lower Quality of Life (QoL) and worse levels of physical activity. This study aimed to evaluate the QoL and level of physical activity of individuals with TMD with and without OS.

METHODS

In this cross-sectional study, 62 individuals with TMD were allocated into 2 groups: TMD with OS (n = 36) or TMD without OS (n = 26). Self-reported complaints of dizziness, vertigo, tinnitus, earache, ear fullness, or hypoacusis were considered as OS. QoL was assessed with the WHOQOL-Bref and physical activity with the IPAQ-SF. Independent t-test and chi-squared test were used for analysis between-groups. Effect sizes were reported using Cohen's d. A Pearson correlation was used to compare the number of OS and QoL scores. A significance level of p < 0.05% and 95% confidence intervals were considered statistically significant.

RESULTS

The total generic scores for QoL were not different between-groups (p = 0.076), but individuals with TMD with OS had lower satisfaction (p = 0.015; d: 0.63) and physical domain (p = 0.015; d: 0.64) scores with a moderate effect size. In TMD with OS, 69.4% of individuals were irregularly active and 50% for the TMD without OS, with no statistical significance (p > 0.05). The number of OSs was inversely and weakly associated with the QoL total score.

CONCLUSION

Individuals with TMD and OS are associated with worsened QoL (physical domain and satisfaction) when compared to individuals with TMD without OS. The higher the number of OS, the worse the QoL score. Individuals with TMD with and without OS had similar levels of physical activity, but a high prevalence of irregularly active and sedentary individuals within TMD diagnosed population was found.

Validity and internal consistency of four scales in patients with TMD: PHQ8, GAD7, PHQ15 and JFLS20

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.

Factors associated with voice-related quality of life among patients with temporomandibular disorders

BACKGROUND

Research would be important for obtaining a better understanding of voice complaints among patients with temporomandibular disorders (TMD).

OBJECTIVE

The identification of predictors of voice disorders associated with TMD pain was made according to Diagnostic Criteria for TMD (DC/TMD) Axis I.

METHODOLOGY

Functional limitations were measured using the Jaw Functional Limitation Scales for mastication (JFLS-M), jaw mobility (JFLS-JM), and verbal and emotional expression (JFLS-VEE). Patients also completed the Hospital Anxiety and Depression Scale (HADS). The primary outcome was social-emotional and physical functioning as indicated by scores on the Voice-Related Quality of Life (V-RQOL) questionnaire. Multiple linear regression was used to model the relationship between the domains on the V-RQOL questionnaire and scores on the HADS and JFLS after adjusting for age, gender, DC/TMD diagnosis, pain intensity, and time since pain onset.

RESULTS

The HADS-D (B=-1.15; 95% CI, -1.718 to -0.587; p<.001) and JFLS-VEE (B=-0.22; 95% CI, -0.40 to -0.06; p=.008) were significant predictors of scores on the V-RQOL questionnaire.

CONCLUSION

Higher scores on depression measures and limitations in verbal and emotional expression could exacerbate voice problems among TMD pain patients. Future research should promote multidisciplinary treatments for TMD pain-related voice disorders.

Impact of professional, recreational and nonsinging on temporomandibular disorders - a comparative study based on a self-assessment questionnaire

BACKGROUND

This study investigates the relationship between professional and recreational singing on temporomandibular disorders (TMDs) in women compared to a nonsinging control group.

METHODS

A total of 288 female subjects between the ages of 18 and 45 participated in the self-assessment questionnaire including demographic data, as well as questions on vocal practice and TMDs symptoms. Depending on the singing time per week, the (non)vocalists were assigned to the groups professional (n = 96), recreational (n = 96) and nonsingers (n = 96).

RESULTS

The TMDs prevalence in professional singers (42%) was higher than that in recreational singers (31%) and noticeably higher than that in nonsingers (25%). The Fisher-Freeman-Halton exact test showed that the differences between the groups were not noticeable (p = .053) but could be formulated as tendencies. The professionals suffered much more from restricted jaw movement (p = .004; OR = 2.718; 95% CI = 1.409-5.242), temporomandibular joint sounds (p < .009; OR = 2.267; 95% CI = 1.264-4.064) and temporomandibular pain (p = .010; OR = 2.333; 95% CI = 1.264-4.308) than nonsingers.

CONCLUSIONS

Singing might have an enhancing effect on the appearance of TMDs. In particular, professional singers suffered more from self-reported TMDs than recreational singers and nonsingers. In addition to the high level of physical workload if participating in professional singing, the psychosocial impact should be investigated more in further studies. No new treatment strategies resulted from this study, as the etiological significance of singing is still unclear. Knowledge about risk factors for multifactorial TMDs can help practitioners and patients prevent and treat TMDs.

Sociodemographic Profile: A Forgotten Factor in Temporomandibular Disorders? A Scoping Review

The literature on Temporomandibular Disorders (TMD) incidence commonly reports sociodemographic factors such as gender and age. However, the role and prevalence of other sociodemographic factors in TMD are not well defined. Therefore, this scoping review aimed to report the prevalence of sociodemographic factors in TMD patients. A systematic search was conducted in the PubMed and Web of Science databases to identify clinical trials in adult populations, using the Research Diagnostic Criteria for TMD (RDC/TMD) or the Diagnostic Criteria for TMD (DC/TMD) and reporting sociodemographic data in TMD patients. Twenty-seven studies meeting the criteria were included in this review. The most commonly reported sociodemographic factors assessed in the included studies were age, race, education, job, income, and marital status. TMD prevalence was observed to be higher among younger and divorced individuals among the included studies. However, conflicting results were found for education level, and employment was not considered a risk factor for TMD. Although this review has methodological limitations, it suggests an association between TMD incidence and certain sociodemographic factors; nevertheless, further studies are needed to establish this relationship more conclusively.

Predicting the relationship between anxiety and health-related quality of life in post-stroke patients: The role of sleep duration

OBJECTIVES

Sleep and psychological disorders are common complaints in stroke survivors. The effectiveness of sleep duration in post-stroke on mental well-being and health outcomes has been reported recently. This study aimed to investigate the mediating effect of sleep duration on the relationship between anxiety and health-related quality of life in Chinese post-stroke; MATERIALS AND METHODS: We conducted a quantitative, cross-sectional study with participants recruited through a multistage, stratified, probability proportional to size sampling method. Anxiety, health-related quality of life, and sleep duration were measured by Zung Self-rating Anxiety Scale, World Health Organization Quality of Life Questionnaire, and a self-administered, structured questionnaire. A multiple linear regression analysis was conducted to identify the association between anxiety, sleep duration, and quality of life. The direct and indirect effects of sleep duration on health-related quality of life was assessed using the bootstrap method via Model 4 (parallel mediation) of SPSS PROCESS macro; RESULTS: A total of 856 post-stroke patients participated in the study, and incidence of anxiety symptom amongst post-stroke was 33.53%. Sleep duration mainly plays partial mediating roles in the relationship between mild-to-moderate anxiety and quality of life in physical, psychological, and environment domains, with sleep duration of 7-8h playing a major role; CONCLUSIONS: A significant relationship among anxiety, sleep duration, and quality of life in post-stroke was found in this study. The sleep duration partially mediated the association between anxiety and quality of life. Suitable prevention methods and early interventions for sleep duration may improve the quality of life for post-stroke anxiety.

Effectiveness of double-puncture temporomandibular joint arthrocentesis with viscosupplementation in different categories of severity - a prospective study

This 3-year prospective study evaluated the efficacy of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation in different severity stages based on the Dimitroulis classification (categories 2-4 were included). TMJ arthrocentesis was performed under local anaesthesia, and the protocol consisted of a double-puncture technique with lavage of ≥150 cc Ringer Lactate plus viscosupplementation. Incobotulinum toxin A was administered 10-15 days preoperatively in patients with concomitant masticatory myalgia. The primary outcome was TMJ pain, assessed by visual analogue scale (VAS, 0-10), and the secondary outcomes were the maximum mouth opening (MMO, mm) and myalgia degree (0-3). All outcomes were assessed on the intervention day (T0) and after the procedure (T1) (minimum 1 month and then 3 months, 6 months, 1 year and every year since). A total of 108 patients were enrolled (mean age of 43.1 ± 18.9 years); 86 (80%) were women and 22 (20%) were men. Preoperative pain was 4.02 ± 3.12 (mean ± SD), MMO was 38.10 ± 9.56 (mean ± SD) and myalgia degree was 1.80 ± 1.18 (mean ± SD). After an average of 215.4 days (31-1253 days), a statistically significant improvement of pain (P < 0.0001), MMO (P = 0.005) and myalgia degree (P < 0.0001) was observed. The overall successful outcome of TMJ arthrocentesis with viscosupplementation was 76%. The authors observed increased arthrocentesis effectiveness and success rate with viscosupplementation in Dimitroulis category 2 (88.6%) compared to 3-4 (71.4%). An association was found between arthrocentesis with viscosupplementation failure and painful myalgia (ρ = 0.477; P < 0.0001). Thirteen patients (12%) underwent a second TMJ intervention after finalising the present trial. With a low complication rate, TMJ arthrocentesis with viscosupplementation led to an overall benefit for all the included patients. This study reinforces the important role of minimally invasive TMJ arthrocentesis as a first treatment option, with better results in the early stages compared to more severe stages.

Comparative effectiveness of hyaluronic acid, platelet-rich plasma, and platelet-rich fibrin in treating temporomandibular disorders: a systematic review and network meta-analysis

OBJECTIVE

This study aims to compare the efficacy of intra-articular injections of hyaluronic acid (HA), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) for treating temporomandibular disorders (TMDs) and summarize their mechanisms of action.

METHODS

Randomized controlled trials (RCTs) published until November 13, 2021, were identified using electronic and manual searches. Each study was evaluated for the risk of bias using the Cochrane risk of bias tool. The studies found via searches were categorized by follow-up time (1, 3, or 6 months). Evidence quality was graded according to the GRADE system.

RESULTS

Twelve RCTs were included that involved 421 patients with TMD. The network meta-analysis showed that all treatment groups improved compared to the placebo groups in terms of pain and maximal mouth opening (MMO). For pain evaluated via the visual analog scale, PRF exhibited better analgesic effects than PRP or HA after 1 and 3 months. PRP appeared to be more effective than PRF was after 6 months but there were no statistically significant differences between the two. For MMO, the effect of PRP was superior to those of PRF and HA after 1 month. However, after 3 and 6 months, PRF provided more encouraging results in improving MMO.

CONCLUSION

PRP and PRF exhibited similar short-term efficacy in treating TMD, while PRF was more advantageous in terms of long-term efficacy. Therefore, PRF was recommended for treating TMD.

Preclinical orofacial pain assays and measures and chronic primary orofacial pain research: where we are and where we need to go

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.

Evaluation of prevalence of temporomandibular disorders based on DC / TMD Axis I diagnosis in Turkish population and correlation with Axis II

PURPOSE

The prevalence of DC / TMD diagnosis of individuals with internal derangement of TMJ who want to receive TMD treatment in a tertiary clinic in the Turkish population and comparison of the criteria applied in Axis I and Axis II.

METHODS

This study was carried out on 200 individuals older than 18 years of age who have internal disorder of Temporomandibular Joint (TMJ). Diagnostic Criteria for Temporomandibular Disorders (DC / TMD) Axis I and II were applied.

RESULTS

The female to male ratio of individuals with internal derangement of TMJ in the Turkish population was 3.5. The Pearson correlation coefficient between the internal derangement of the Right TMJ and the internal derangement of the Left TMJ is 0.804 and has a statistically significant relationship (p <0.05).

CONCLUSIONS

For DC / TMD, a more comprehensive study is needed to compare the results found in the Turkish population with other populations.

Temporomandibular disorder severity and its association with psychosocial and sociodemographic factors in Turkish adults

BACKGROUND

There is a lack of awareness regarding temporomandibular disorder (TMD) and its association with psychological and sociodemographic factors in the Turkish population. This study aimed to evaluate the relationship between signs/symptoms of anxiety-depression, sociodemographic factors, parafunctional habits, bruxism, and the presence and severity of the symptoms of TMD in Turkish adults.

METHODS

The participants completed an online questionnaire consisting of sociodemographic questions, the Fonseca Anamnestic Index, and the Patient Health Questionnaire-4.

RESULTS

The mean age of the 2580 participants was 35.29 ± 12.70 years, and 63.3% were women. The frequency of the participants who showed symptoms of TMD was 69.8%. The severity of TMD symptoms was significantly greater in participants who had signs/symptoms of anxiety and depression (p < 0.05). Sociodemographic and psychological data showed an association between the presence and severity of the symptoms of TMD and sex (OR 1.52, 95% confidence interval (CI) 1.26-1.85), parafunctional habits (OR 2.64, 95% CI 2.36-2.99), bruxism (OR 3.14, 95% CI 1.78-4.90), signs/symptoms of anxiety (OR 2.30, 95% CI 1.76-3.00), and signs/symptoms of depression (OR 1.90, 95% CI 1.48-2.42).

CONCLUSIONS

The results of the present study suggest that females and those who report bruxism, parafunctional habits, and signs/symptoms of anxiety-depression are more likely to show symptoms of TMD with different severity.

Psychological and Behavioral Factors Involved in Temporomandibular Myalgia and Migraine: Common but Differentiated Profiles

BACKGROUND

Many studies have revealed high comorbidity and a clear association between temporomandibular disorders (TMD) and migraine. Furthermore, evidence points out that common psychological and behavioral factors might be related to the observed TMD and migraine association. However, this association and the underlying psychological factors are poorly understood.

OBJECTIVE

The main goal of this study was to describe the psychological and behavioral factors involved in TMD myalgia and migraine.

METHODS

A sample of 142 participants were recruited to form 4 groups: migraine patients (ICHD-III criteria), painful-TMD patients (Myalgia DC/TMD criteria), patients suffering from both pathologies according to the same criteria, and control patients. After a dental and neurological examination, the patients filled several psychological questionnaires validated for the Spanish population to assess anxiety (STAI), depression (DEP), stress coping (CRI), and somatic, anxiety, and depression symptoms (BSI-18).

RESULTS

The TMD myalgia patients, in general, showed a state of elevated anxiety, somatization, and reduced coping strategies, while the patients with migraine presented greater anxiety symptoms, depression (dysthymia trait and state), and somatization.

CONCLUSIONS

According to the data of the present study, situational anxiety (transient emotional state), together with the lack of coping strategies, could be more associated with TMD myalgia, while anxiety, as a more stable and long-lasting emotional state, together with depression, might be more related to migraine. Further longitudinal studies are needed to unravel whether these differentiated profiles are a consequence or possible risk factors for migraine and TMD.

Association between depression and temporomandibular dysfunction in adults - a systematic review

OBJECTIVE

To critically evaluate the literature and answer the question: "Is there an association between depression and temporomandibular disorder (TMD) in adults?"

METHODS

The personalized search strategy was applied to PubMed, Embase, Web of Science, and Scopus databases. Articles were selected in two stages according to the eligibility criteria. The Joanna Briggs Institute (JBI) tool was used to analyze the risk of bias according to the type of study.

RESULTS

The included articles presented a moderate risk of bias. Based on the studies, individuals with TMD have higher levels of depression compared to the control group. There is also a direct association in that individuals with depression are more susceptible to developing TMD.

CONCLUSION

There is a probable association between depression and TMD in adults. However, more studies with high methodological quality are needed to confirm this finding.

Pain, deep neck flexors performance, disability, and head posture in individuals with temporomandibular disorder with and without otological complaints

BACKGROUND

Otological complaints (OC) are highly prevalent in subjects with temporomandibular disorders (TMD) and so is the risk of neck dysfunctions.

OBJECTIVE

To evaluate pain, deep neck flexor (DNF) performance, disability, and head and neck posture of individuals with TMD with and without OC.

METHODS

In this cross-sectional study, 57 individuals were divided into a group with TMD and OC (n= 31) and a group with TMD without OC (n= 26). Self-reported pain intensity, masticatory and neck muscles pressure pain thresholds, DNF performance, neck disability, and head and neck posture were evaluated. Data were compared between groups using the independent t test and Mann-Whitney test with Bonferroni correction for multiple comparisons. Effect sizes were evaluated using Cohen's index.

RESULTS

The TMD with OC group presented less muscle activation [26 (24-28) vs. 24 (24-26) mmHg; p< 0.05], less endurance [105 (46-140) vs. 44 (28-78) points; p< 0.05], and greater neck disability (8.15 ± 5.89 vs. 13.32 ± 6.36 points; p< 0.05). No significant difference was observed in self-reported pain, head and neck posture, or pressure pain thresholds.

CONCLUSION

Individuals with TMD with OC presented decreased DNF performance and increased neck disability compared to individuals with TMD without OC.

Are neck pain, disability, and deep neck flexor performance the same for the different types of temporomandibular disorders?

OBJECTIVE

To evaluate neck pain, disability, and deep neck flexor (DNF) performance of individuals with temporomandibular disorders (TMD).

METHODS

Eighty individuals were divided into the following: arthrogenic TMD (n = 40), myogenic TMD (n = 12), and mixed TMD (n = 28). Neck pain intensity, neck disability, and DNF performance were evaluated.

RESULTS

Individuals with arthrogenic TMD reported lower intensity of neck pain when compared to mixed TMD (p = 0.01). Individuals with arthrogenic TMD had less neck disability than individuals with myogenic TMD (p = 0.037) and mixed TMD (p < 0.001). A moderate positive correlation was found between neck pain and neck disability (p < 0.001). No differences were found for DNF performance.

CONCLUSION

Neck pain and disability differs according to subtype of TMD, but performance of the deep neck flexors does not. Neck pain intensity and neck disability were correlated in patients with TMD.

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.

Effects of therapeutic exercise and aerobic exercise programmes on pain, anxiety and oral health-related quality of life in patients with temporomandibular disorders

BACKGROUND

Pain and anxiety contribute to decreasing quality of life related to oral health in patients with temporomandibular disorders (TMD). Evidence-based practice has shown that therapeutic and aerobic exercise programmes are adequate strategies for modifying these factors.

OBJECTIVE

To assess the effects of aerobic exercise on pain, anxiety and quality of life related to oral health in patients with TMD.

METHODS

Forty-five patients diagnosed with TMD were divided into three groups of 15 participants: a therapeutic exercise programme (G1, mean 26.9 ± 5.5 years), a therapeutic and aerobic exercise programme (G2, mean 26 ± 4.4 years) and an aerobic exercise programme (G3, mean 24.9 ± 3.4 years). Pain intensity was assessed using a numerical rating scale (NRS), anxiety level and quality of life related to oral health through GAD-7 and OHIP-14, respectively. These parameters were evaluated twice at baseline (T0a/T0b), ending 8-week intervention period (T1) and 8-12 weeks after ending intervention (T2).

RESULTS

NRS significantly decreased in G1 (mean difference T0a/T1 = 5.2, p ˂ .001), G2 (mean difference T0a/T1 = 6.0, p ˂ .001) and G3 (mean difference T0a/T1 = 2.2, p = 0.001). OHIP-14 significantly decreased in G1 (mean difference T0a/T1 = 13.5, p ˂ .001) and G2 (mean difference T0a/T1 = 15.8, p ˂ 0.001) but not in G3 (mean difference T0a/T1 = 1.2, p = 0.55). There were no significant differences between groups regarding GAD-7. Between T1 and T2, there were no significant differences in variables.

CONCLUSION

Therapeutic exercises and therapeutic excercises combined with aerobic exercise groups had a significant decrease in pain and oral health-related quality of life at 8 and 12 weeks. These decreases were not seen for the aerobic exercise group.

Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management

Temporomandibular disorders (TMD) are a group of orofacial pain conditions which are the most common non-dental pain complaint in the maxillofacial region. Due to the complexity of the etiology, the diagnosis and management of TMD remain a challenge where consensus is still lacking in many aspects. While clinical examination is considered the most important process in the diagnosis of TMD, imaging may serve as a valuable adjunct in selected cases. Depending on the type of TMD, many treatment modalities have been proposed, ranging from conservative options to open surgical procedures. In this review, the authors discuss the present thinking in the etiology and classification of TMD, followed by the diagnostic approach and the current trend and controversies in management.

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.