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Lee KS, Jha N, Kim YJ. Risk factor assessments of temporomandibular disorders via machine learning. Sci Rep 2021; 11:19802. [PMID: 34611188 PMCID: PMC8492627 DOI: 10.1038/s41598-021-98837-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/15/2021] [Indexed: 02/08/2023] Open
Abstract
This study aimed to use artificial intelligence to determine whether biological and psychosocial factors, such as stress, socioeconomic status, and working conditions, were major risk factors for temporomandibular disorders (TMDs). Data were retrieved from the fourth Korea National Health and Nutritional Examination Survey (2009), with information concerning 4744 participants' TMDs, demographic factors, socioeconomic status, working conditions, and health-related determinants. Based on variable importance observed from the random forest, the top 20 determinants of self-reported TMDs were body mass index (BMI), household income (monthly), sleep (daily), obesity (subjective), health (subjective), working conditions (control, hygiene, respect, risks, and workload), occupation, education, region (metropolitan), residence type (apartment), stress, smoking status, marital status, and sex. The top 20 determinants of temporomandibular disorders determined via a doctor's diagnosis were BMI, age, household income (monthly), sleep (daily), obesity (subjective), working conditions (control, hygiene, risks, and workload), household income (subjective), subjective health, education, smoking status, residence type (apartment), region (metropolitan), sex, marital status, and allergic rhinitis. This study supports the hypothesis, highlighting the importance of obesity, general health, stress, socioeconomic status, and working conditions in the management of TMDs.
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Affiliation(s)
- Kwang-Sig Lee
- grid.222754.40000 0001 0840 2678AI Center, Korea University College of Medicine, Seoul, Korea
| | - Nayansi Jha
- grid.267370.70000 0004 0533 4667Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Yoon-Ji Kim
- grid.267370.70000 0004 0533 4667Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
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Karkazi F, Özdemir F. Temporomandibular Disorders: Fundamental Questions and Answers. Turk J Orthod 2021; 33:246-252. [PMID: 33447468 DOI: 10.5152/turkjorthod.2020.20031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022]
Abstract
This review aimed to present the current evidence-based answers to a questionnaire which was developed to evaluate the beliefs and knowledge of dental professionals concerning temporomandibular disorder (TMD). A literature review was conducted using the PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane, Google Scholar, and Scopus search engines from January 1980 to June 2020 corresponding to TMD diagnosis, causes, management, and consequences. A total of 50 articles were considered relevant and selected for full review. The etiology of TMD is multifactorial and complicated and involves several direct and indirect factors. Orthodontic treatment does not appear to either prevent or relieve TMD to a great degree. Nevertheless, condylar and occlusal stability reduces the risk of TMD development. As a result, an assessment of the function of masticatory system prior to beginning orthodontic therapy is fundamental. If signs and symptoms of TMD are significantly present, they should be managed before any orthodontic intervention. Moreover, psychological disorders are strongly associated with joint and facial pain. Thus, professionals who work with chronic TMD patients need to be aware of the psychological aspects of chronic pain and refer the patient for psychological evaluation when warranted. Future research elucidating a cause-effect relationship and neurobehavioral processes underlining chronic pain should be performed.
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Affiliation(s)
| | - Fulya Özdemir
- Department of Orthodontics, Marmara University, Istanbul, Turkey
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Kindler S, Schwahn C, Terock J, Mksoud M, Bernhardt O, Biffar R, Völzke H, Metelmann HR, Grabe HJ. Alexithymia and temporomandibular joint and facial pain in the general population. J Oral Rehabil 2018; 46:310-320. [PMID: 30472782 DOI: 10.1111/joor.12748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/23/2018] [Accepted: 11/17/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Associations of alexithymia with temporomandibular pain disorders (TMD), facial pain, head pain and migraine have been described, but the role of the different dimensions of alexithymia in pain development remained incompletely understood. OBJECTIVES We sought to investigate the associations of alexithymia and its subfactors with signs of TMD and with facial pain, head pain and migraine in the general population. METHODS A total of 1494 subjects from the general population completed the Toronto Alexithymia Scale-20 (TAS-20) and underwent a clinical functional examination with palpation of the temporomandibular joint and masticatory muscles. Facial pain, migraine and head pain were defined by questionnaire. A set of logistic regression analyses was applied with adjustment for age, sex, education, number of traumatic events, depressive symptoms and anxiety. RESULTS Alexithymia was associated with TMD joint pain (Odds Ratio 2.63; 95% confidence interval 1.60-4.32 for 61 TAS-20 points vs the median of the TAS-20 score) and with facial pain severity (Odds Ratio 3.22; 95% confidence interval 1.79-5.79). Differential effects of the subfactors were discovered with difficulties in identifying feelings as main predictor for joint, facial, and head pain, and externally oriented thinking (EOT) as U-shaped and strongest predictor for migraine. CONCLUSION Alexithymia was moderately to strongly associated with signs and symptoms of TMD. These results should encourage dental practioners using the TAS-20 in clinical practice, to screen TMD, facial or head pain patients for alexithymia and could also help treating alexithymic TMD, facial or head pain patients.
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Affiliation(s)
- Stefan Kindler
- Department of Oral and Maxillofacial Surgery / Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Christian Schwahn
- Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Jan Terock
- Department of Psychiatry and Psychotherapy, Helios Hanseklinikum, University Medicine Greifswald, Stralsund, Germany
| | - Maria Mksoud
- Department of Oral and Maxillofacial Surgery / Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Olaf Bernhardt
- Department of Restorative Dentistry, Periodontology and Endodontology, University Medicine Greifswald, Greifswald, Germany
| | - Reiner Biffar
- Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute of Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Hans Robert Metelmann
- Department of Oral and Maxillofacial Surgery / Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
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Han W, Kwon SC, Lee YJ, Park C, Jang EC. The associations between work-related factors and temporomandibular disorders among female full-time employees: findings from the Fourth Korea National Health and Nutrition Examination Survey IV (2007-2009). Ann Occup Environ Med 2018; 30:42. [PMID: 29977568 PMCID: PMC6011415 DOI: 10.1186/s40557-018-0253-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/12/2018] [Indexed: 11/12/2022] Open
Abstract
Background The aim of this study was to investigate the association between work-related factors and temporomandibular disorders (TMD) among female full-time employees using representative data from a national population-based survey. Methods Data from the Fourth Korea National Health and Nutrition Examination Survey IV (2007–2009) were used to analyze 1,612 women. Complex samples logistic regression was applied for adjusting for general characteristics and work-related factors to examine the association between work-related factors and TMD. Results The prevalence of TMD was 12.8% in this study population. With respect to age, educational status, marital status, problem drinking, exercise, and stress, there were statistically significant differences in the prevalence of TMD. In logistic regression analyses on complex samples, based on 40 h or less per week, odds ratios (ORs) for respondents who worked 40–48 working hours, 49–60 working hours, and more than 60 h were 1.16 (95% confidence interval (CI) 0.69–1.94), 1.41 (95% CI 0.79–2.54), and 2.43 (95% CI 1.29–4.59), after adjusting for general characteristics, working schedule, employment status, and occupation. Conclusions This study found that long working hours were significantly associated with TMD in Korean female full-time employees.
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Affiliation(s)
- Wook Han
- 1Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Soon-Chan Kwon
- 1Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Yong-Jin Lee
- 1Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea.,2Environmental Health Center for Asbestos, Soonchunhyang University Cheonan Hospital, 67, Suncheonhyang 3-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Chan Park
- 1Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Eun-Chul Jang
- 1Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
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Visscher CM, van Wesemael-Suijkerbuijk EA, Lobbezoo F. Is the experience of pain in patients with temporomandibular disorder associated with the presence of comorbidity? Eur J Oral Sci 2016; 124:459-464. [DOI: 10.1111/eos.12295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Corine M. Visscher
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University Amsterdam; MOVE Research Institute Amsterdam; Amsterdam the Netherlands
| | - Erin A. van Wesemael-Suijkerbuijk
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University Amsterdam; MOVE Research Institute Amsterdam; Amsterdam the Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University Amsterdam; MOVE Research Institute Amsterdam; Amsterdam the Netherlands
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Yang SE, Park YG, Han K, Min J, Kim S. Association between dental pain and depression in Korean adults using the Korean National Health and Nutrition Examination Survey. J Oral Rehabil 2015; 43:51-8. [DOI: 10.1111/joor.12343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S. E. Yang
- Department of Conservative Dentistry; Seoul St. Mary's Dental Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Y. G. Park
- Department of Biostatistics; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - K. Han
- Department of Biostatistics; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - J.A. Min
- Department of Psychiatry; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - S.Y. Kim
- Department of Conservative Dentistry; Seoul St. Mary's Dental Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
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Theorell TP, Lennartsson AK, Mosing MA, Ullén F. Musical activity and emotional competence - a twin study. Front Psychol 2014; 5:774. [PMID: 25076933 PMCID: PMC4100574 DOI: 10.3389/fpsyg.2014.00774] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/01/2014] [Indexed: 12/05/2022] Open
Abstract
The hypothesis was tested that musical activities may contribute to the prevention of alexithymia. We tested whether musical creative achievement and musical practice are associated with lower alexithymia. 8000 Swedish twins aged 27–54 were studied. Alexithymia was assessed using the Toronto Alexithymia Scale-20. Musical achievement was rated on a 7-graded scale. Participants estimated number of hours of music practice during different ages throughout life. A total life estimation of number of accumulated hours was made. They were also asked about ensemble playing. In addition, twin modelling was used to explore the genetic architecture of the relation between musical practice and alexithymia. Alexithymia was negatively associated with (i) musical creative achievement, (ii) having played a musical instrument as compared to never having played, and – for the subsample of participants that had played an instrument – (iii) total hours of musical training (r = -0.12 in men and -0.10 in women). Ensemble playing added significant variance. Twin modelling showed that alexithymia had a moderate heritability of 36% and that the association with musical practice could be explained by shared genetic influences. Associations between musical training and alexithymia remained significant when controlling for education, depression, and intelligence. Musical achievement and musical practice are associated with lower levels of alexithymia in both men and women. Musical engagement thus appears to be associated with higher emotional competence, although effect sizes are small. The association between musical training and alexithymia appears to be entirely genetically mediated, suggesting genetic pleiotropy.
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Affiliation(s)
- Töres P Theorell
- Department of Neuroscience, Karolinska Institute Stockholm, Sweden ; Stress Research Institute, Stockholm University Stockholm Sweden
| | | | - Miriam A Mosing
- Department of Neuroscience, Karolinska Institute Stockholm, Sweden
| | - Fredrik Ullén
- Department of Neuroscience, Karolinska Institute Stockholm, Sweden
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Castelli L, De Santis F, De Giorgi I, Deregibus A, Tesio V, Leombruni P, Granieri A, Debernardi C, Torta R. Alexithymia, anger and psychological distress in patients with myofascial pain: a case-control study. Front Psychol 2013; 4:490. [PMID: 23914181 PMCID: PMC3728491 DOI: 10.3389/fpsyg.2013.00490] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/12/2013] [Indexed: 12/22/2022] Open
Abstract
Aims: The aim of this study was to investigate psychological distress, anger and alexithymia in a group of patients affected by myofascial pain (MP) in the facial region. Methods: 45 MP patients [mean (SD) age: 38.9 (11.6)] and 45 female healthy controls [mean (SD) age: 37.8 (13.7)] were assessed medically and psychologically. The medically evaluation consisted of muscle palpation of the pericranial and cervical muscles. The psychological evaluation included the assessment of depression (Beck Depression Inventory—short form), anxiety [State-Trait Anxiety Inventory Form Y (STAI-Y)], emotional distress [Distress Thermometer (DT)], anger [State-Trait Anger Expression Inventory—2 (STAXI-2)], and alexithymia [Toronto Alexithymia Scale (TAS)]. Results: the MP patients showed significantly higher scores in the depression, anxiety and emotional distress inventories. With regard to anger, only the Anger Expression-In scale showed a significant difference between the groups, with higher scores for the MP patients. In addition, the MP patients showed significantly higher alexithymic scores, in particular in the Difficulty in identifying feelings (F1) subscale of the TAS-20. Alexithymia was positively correlated with the Anger Expression-In scale. Both anger and alexithymia showed significant positive correlations with anxiety scores, but only anger was positively correlated with depression. Conclusion: A higher prevalence of depressive and anxiety symptoms associated with a higher prevalence of alexithymia and expression-in modality to cope with anger was found in the MP patients. Because the presence of such psychological aspects could contribute to generate or exacerbate the suffering of these patients, our results highlight the need to include accurate investigation of psychological aspects in MP patients in normal clinical practice in order to allow clinicians to carry out more efficacious management and treatment strategies.
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Affiliation(s)
- Lorys Castelli
- Department of Psychology, University of Turin Turin, Italy
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Nishiyama A, Kino K, Sugisaki M, Tsukagoshi K. Influence of psychosocial factors and habitual behavior in temporomandibular disorder-related symptoms in a working population in Japan. Open Dent J 2012; 6:240-7. [PMID: 23346261 PMCID: PMC3551253 DOI: 10.2174/1874210601206010240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/09/2012] [Accepted: 10/23/2012] [Indexed: 02/02/2023] Open
Abstract
Background: The symptoms of temporomandibular disorders (TMD) are directly influenced by numerous factors, and it is thought that additional factors exert indirect influences. However, the relationships between TMD-related symptoms (TRS) and these contributing factors are largely unknown. Thus, the goal of the present study was to investigate influences on TRS in a working population by determining the prevalence of TRS, analyzing contributing factors, and determining their relative influences on TRS. Materials and Methods: The study subjects were 2203 adults who worked for a single company. Subjects completed a questionnaire assessing TRS, psychosocial factors (stress, anxiety, depressed mood, and chronic fatigue), tooth-contacting habit, and sleep bruxism-related morning symptoms, using a 5-point numeric rating scale. Our analysis proceeded in 2 phases. First, all variables of the descriptor were divided into parts by using an exploratory factor analysis. Second, this factorial structure was verified by using a confirmatory factor analysis with structural equation modeling. Results: Of 2203 employees, 362 reported experiencing TRS (16.4%). Structural equation modeling generated a final model with a goodness of fit index of 0.991, an adjusted goodness of fit index of 0.984, and a root mean square error of approximately 0.021. These indices indicate a strong structural model. The standardized path coefficients for “habitual behavioral factors and TRS,” “psychosocial factors and habitual behavioral factors,” “psychosocial factors and TRS,” and “gender and habitual behavior factors” were 0.48, 0.38, 0.14, and 0.18, respectively. Conclusions: Habitual behavioral factors exert a stronger effect on TRS than do psychosocial factors.
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Affiliation(s)
- Akira Nishiyama
- Temporomandibular Joint and Oral Function, Comprehensive Oral Health Care, Comprehensive Patient Care, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Haas J, Eichhammer P, Traue HC, Hoffmann H, Behr M, Crönlein T, Pieh C, Busch V. Alexithymic and somatisation scores in patients with temporomandibular pain disorder correlate with deficits in facial emotion recognition. J Oral Rehabil 2012; 40:81-90. [PMID: 23137311 DOI: 10.1111/joor.12013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2012] [Indexed: 01/05/2023]
Abstract
Current studies suggest dysfunctional emotional processing as a key factor in the aetiology of temporomandibular disorder (TMD). Investigating facial emotion recognition (FER) may offer an elegant and reliable way to study emotional processing in patients with TMD. Twenty patients with TMD and the same number of age-, sex- and education-matched controls were measured with the Facially Expressed Emotion Labelling (FEEL) test, the 26-item Toronto Alexithymia Scale (TAS-26), the Screening for Somatoform Symptoms (SOMS-2a), the German Pain Questionnaire and the 21-item Hamilton Depression Rating Scale (HAMD). The patients had significantly lower Total FEEL Scores (P = 0·021) as compared to the controls, indicating a lower accuracy of FER. Furthermore, we were able to demonstrate significant group differences with respect to the following issues: patients were more alexithymic (P = 0·006), stated more somatoform symptoms (P < 0·004) and had higher depressive scores in the HAMD (P < 0·003). The factors alexithymia and somatisation could explain 31% (adjusted 27%) of the variance of the FEEL Scores in the sample. The estimation of the standardised regression coefficients suggests an equivalent influence of TAS-26 and SOMS-2a on the FEEL Scores, whereas 'group' (patients versus healthy controls) and depressive symptoms did not contribute significantly to the model. Our findings highlight FER deficits in patients with TMD, which are partially explained by concomitant alexithymia and somatisation. As suggested previously, impaired FER in patients with TMD may further point to probable aetiological proximities between TMD and somatoform disorders.
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Affiliation(s)
- J Haas
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany.
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Nishiyama A, Kino K, Sugisaki M, Tsukagoshi K. A survey of influence of work environment on temporomandibular disorders-related symptoms in Japan. Head Face Med 2012; 8:24. [PMID: 22995447 PMCID: PMC3517325 DOI: 10.1186/1746-160x-8-24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/19/2012] [Indexed: 11/24/2022] Open
Abstract
Introduction This study aimed at identifying the factors that influence the incidence of temporomandibular disorders (TMD)-related symptoms (TRS) in a Japanese working population. Methods Our study subjects comprised of 1,969 employees from the same Japanese company. The subjects were assessed using a questionnaire that covered both TRS and the work environment. TRS were measured from 4 items on the questionnaire. The work environment factors recorded were the daily mean duration of personal computer use, driving, precise work, commuting, time spent at home before going to bed, sleeping, attending business meetings, and performing physical labor. Statistical analysis was performed using t-tests, Chi-square tests, and logistic regression analyses. A result with P < 0.05 was considered statistically significant. Results The median total score on the 4 items used to assess TRS was 5 (25% = 4, 75% = 7). Two groups were defined such that the participants scoring ≤7 were assigned to the low-TRS group and those scoring ≥8, to the high-TRS group. The high-TRS group constituted 22.6% of the subjects. Logistic regression analyses indicated that female gender and extended periods of computer use were significant contributors to the manifestation of TRS. Conclusion This questionnaire-based study showed that gender and computer use time was associated with the prevalence of TRS in this working population. Thus, evaluation of ergonomics is suggested for TMD patients.
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Affiliation(s)
- Akira Nishiyama
- Section of Temporomandibular Joint and Oral Function, Department of Comprehensive Patient Care, Graduate School, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Japan.
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Wehrens SMT, Hampton SM, Kerkhofs M, Skene DJ. Mood, Alertness, and Performance in Response to Sleep Deprivation and Recovery Sleep in Experienced Shiftworkers Versus Non-Shiftworkers. Chronobiol Int 2012; 29:537-48. [DOI: 10.3109/07420528.2012.675258] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hosoi M, Molton IR, Jensen MP, Ehde DM, Amtmann S, O'Brien S, Arimura T, Kubo C. Relationships among alexithymia and pain intensity, pain interference, and vitality in persons with neuromuscular disease: Considering the effect of negative affectivity. Pain 2010; 149:273-277. [PMID: 20207082 DOI: 10.1016/j.pain.2010.02.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 01/28/2010] [Accepted: 02/08/2010] [Indexed: 01/22/2023]
Abstract
Alexithymia, the inability to identify or label emotions, has been shown to be associated with pain in patients with a number of chronic pain conditions. We sought to: (1) replicate this association in samples of persons with chronic pain secondary to neuromuscular disease, (2) extend this finding to other important pain-related measures, and (3) to determine whether relationships among alexithymia and study variables existed after controlling for negative affect. One hundred and twenty-nine individuals with muscular dystrophy and chronic pain were administered measures of alexithymia (Toronto Alexithymia Scale, TAS-20), pain intensity (0-10 NRS), pain interference (Brief Pain Inventory Interference scale), mental health (SF-36 Mental Health scale; as a proxy measure of negative affect) and vitality (SF-36 Vitality scale). Higher TAS scores were associated significantly with higher pain intensity and interference, and less vitality. Although the strengths of these associations were reduced when mental health was used as a control, the associations between the Difficulty Identifying Feelings scale and vitality, and the Externally Oriented Thinking and Total TAS scales and pain intensity remained statistically significant. The findings replicate and extend previous findings concerning the associations between alexithymia and important pain-related variables in a sample of persons with chronic pain and neuromuscular disease. Future research is needed to determine the extent to which the associations are due to (1) a possible causal effect of alexithymia on patient functioning that is mediated via its effects on negative affect or (2) the possibility that alexithymia/outcome relationships reflect response bias caused by general negative affectivity.
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Affiliation(s)
- Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 356490, Seattle, WA, USA Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
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Anxiety and depression in patients with chronic temporomandibular pain and in controls. J Dent 2010; 38:369-76. [PMID: 20079799 DOI: 10.1016/j.jdent.2010.01.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 12/02/2009] [Accepted: 01/09/2010] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the prevalence of anxiety and depression in temporomandibular disorders (TMD) patient subgroups and in controls with or without chronic facial pain (CFP). METHODS Our sample consisted of 61 men and 161 women. All TMD patients had suffered from pain for at least 6 months and were divided into two subgroups-an exclusively myofascial pain group and an exclusively joint pain group. Subjects without signs or symptoms of TMD but with and without CFP served as controls. All subjects were examined by calibrated examiners in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders. The German version of the Hospital Anxiety and Depression Scale was used for assessment of anxiety and depression. Analysis of covariance was used to determine the effects of sex, age, and subgroup on anxiety and depression scores. Additional t-tests were performed and the subgroups were then compared with those from a general population sample. RESULTS Females from the exclusively myofascial pain group were significantly more depressed than those from the general population or from the exclusively joint pain group. Male controls with CFP were significantly more depressed than female CFP controls. For anxiety, no significant effect of sex or subgroup was found. CONCLUSIONS Depression may play an important role in women with chronic myofascial pain whereas anxiety does not seem to be relevant for either females or males. Further anxiety screening of patients with temporomandibular pain could not be justified.
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Porcelli P, Tulipani C, Maiello E, Cilenti G, Todarello O. Alexithymia, coping, and illness behavior correlates of pain experience in cancer patients. Psychooncology 2007; 16:644-50. [PMID: 17094162 DOI: 10.1002/pon.1115] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper aimed to investigate the role played by key psychological factors in the experience of pain in cancer. One hundred and eight consecutive cancer patients were administered validated scales for pain, alexithymia, coping with cancer, and illness behavior. Two groups of patients with (n=45, 42%) and without (n=63, 58%) current pain were compared. Pain was associated to tumor sites and status, poor adjustment to cancer, and higher disease conviction and perception, but not to global alexithymia. However, the component of difficulty identifying feelings (DIF) of the alexithymia construct was significantly higher in pain patients compared to pain-free patients (t=2.88, p<0.01), constituted one of the independent predictors of pain (r=0.37; beta=0.27, p<0.01), and correlated with quality descriptors of pain (r=0.33, p<0.05). The present findings showed for the first time that although alexithymia was not globally related to cancer pain, the DIF component was however associated to pain dimensions, thus suggesting it might be involved in the way patients describe their pain experience, together with maladaptive coping and abnormal illness behavior. Cancer patients experiencing pain should be helped to adopt a more adaptive coping with the disease by identifying more accurately the source of their feelings.
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Affiliation(s)
- Piero Porcelli
- Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Bari, Italy.
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Abstract
OBJECTIVE To clarify the relationship of global alexithymia and its facets with pain, assessed prospectively using experience sampling methods (ESMs), in temporomandibular disorder (TMD). METHODS People with painful TMD (n=49), pain-free somatic controls (24 people with disk displacement), and healthy controls (n = 28) completed measures of alexithymia (Toronto Alexithymia Scale-20 [TAS-20]) and depressed mood. Patients with painful TMD used ESM to record jaw pain multiple times daily for a week. RESULTS The somatic and the healthy controls were equivalent on alexithymia and were combined. The painful TMD group had higher difficulty in identifying feelings but lower externally oriented thinking (EOT); only the latter effect remained after covarying depressed mood. Among patients with painful TMD, the TAS-20 total and EOT correlated positively with pain severity after controlling for depressed mood. CONCLUSION Findings highlight the complex relationships of alexithymia and its facets to TMD pain. Research should examine alexithymia facets separately and distinguish between methods that compare groups on alexithymia (e.g., pain patients versus controls) and those that correlate alexithymia with pain severity within a group.
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Affiliation(s)
- Alan G Glaros
- Department of Internal Medicine, Kansas City University of Medicine and Biosciences, MO 64106, USA.
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