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Christidis N, Al-Moraissi EA, Al-Ak'hali MS, Minarji N, Zerfu B, Grigoriadis A, Schibbye R, Christidis M. Psychological treatments for temporomandibular disorder pain-A systematic review. J Oral Rehabil 2024; 51:1320-1336. [PMID: 38616535 DOI: 10.1111/joor.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMD) are common. They affect abilities for carrying out daily tasks and influence different psychological aspects. In addition to standard treatment, psychological treatments have been suggested. The aim was to investigate the effects of psychological treatments on patients with painful TMD in a short- and long-term perspective. MATERIALS AND METHODS An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL), and Web of Science for randomized clinical trials (RCTs) reporting psychological interventions for TMD. Registered beforehand in PROSPERO (CRD42022320106). In total, 18 RCTs were included; six RCTs that could be used in the meta-analysis, and all 18 RCTs were used in the narrative synthesis. Risk of bias was assessed by the Cochrane's tool for assessing risk of bias and certainty of evidence by GRADE. RESULTS The narrative synthesis indicates that psychological treatment options seem equivalent to standard treatment for painful TMD. The meta-analysis showed that a combination of psychological treatment and standard treatment and manual treatment (very low-quality evidence) are significantly better in pain reduction than just counselling and standard treatments of TMD. CONCLUSION This study indicates that psychological treatments seem to reduce pain intensity in individuals with painful TMD, and that the effect seems to be equally good as standard treatment. However, a combination of psychological treatments and standard treatments seems to have an even better effect. This indicates that psychological treatments are promising as an additional treatment approach for painful TMDs.
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Affiliation(s)
- Nikolaos Christidis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen
| | | | - Natalie Minarji
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Bethel Zerfu
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Anastasios Grigoriadis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Robert Schibbye
- Department of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Maria Christidis
- The Swedish Red Cross University, The Institute of Health Sciences, Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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2
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Zieliński G, Gawda P. Analysis of the Use of Sample Size and Effect Size Calculations in a Temporomandibular Disorders Randomised Controlled Trial-Short Narrative Review. J Pers Med 2024; 14:655. [PMID: 38929876 PMCID: PMC11204826 DOI: 10.3390/jpm14060655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Temporomandibular disorder (TMD) is the term used to describe a pathology (dysfunction and pain) in the masticatory muscles and temporomandibular joint (TMJ). There is an apparent upward trend in the publication of dental research and a need to continually improve the quality of research. Therefore, this study was conducted to analyse the use of sample size and effect size calculations in a TMD randomised controlled trial. METHODS The period was restricted to the full 5 years, i.e., papers published in 2019, 2020, 2021, 2022, and 2023. The filter article type-"Randomized Controlled Trial" was used. The studies were graded on a two-level scale: 0-1. In the case of 1, sample size (SS) and effect size (ES) were calculated. RESULTS In the entire study sample, SS was used in 58% of studies, while ES was used in 15% of studies. CONCLUSIONS Quality should improve as research increases. One factor that influences quality is the level of statistics. SS and ES calculations provide a basis for understanding the results obtained by the authors. Access to formulas, online calculators and software facilitates these analyses. High-quality trials provide a solid foundation for medical progress, fostering the development of personalized therapies that provide more precise and effective treatment and increase patients' chances of recovery. Improving the quality of TMD research, and medical research in general, helps to increase public confidence in medical advances and raises the standard of patient care.
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Affiliation(s)
- Grzegorz Zieliński
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Piotr Gawda
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
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3
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Yap AU, Dewi NL, Marpaung C. Comorbidities between temporomandibular disorders and somatization in young adults: exploring links with personality, emotional, and sleep disturbances. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:493-500. [PMID: 38480071 DOI: 10.1016/j.oooo.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/07/2023] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The comorbidities between temporomandibular disorders (TMDs) and somatization and their associations with personality traits, emotional disorders, and sleep disturbances were investigated. STUDY DESIGN Adults aged 18 to 24 years completed an electronic survey encompassing TMD symptoms (5Ts), Patient Health Questionnaire-15, Big Five Personality Inventory-10, Depression Anxiety Stress Scales-21, and Pittsburgh Sleep Quality Index. Data were assessed using non-parametric tests/correlation analysis and logistic regression analysis (α = 0.05). RESULTS The sample comprised 365 participants, of whom 22.2% and 19.5% were 5Ts-negative without and with somatization, respectively, and 18.1% and 40.3% were 5Ts-positive without and with somatization, respectively. Significant differences in neuroticism, distress, depression, anxiety, stress, and sleep quality were observed between 5Ts-negative participants with somatization and 5Ts-positive participants with somatization compared with 5Ts-negative participants without somatization and 5Ts-positive participants without somatization. Distress, anxiety, stress, and sleep were moderately correlated with somatic but not TMD symptoms (rs = 0.45-0.52). CONCLUSIONS Irrespective of whether they had TMDs, participants with somatization exhibited heightened levels of neuroticism and emotional and sleep disturbances.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia; Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore; National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, SingHealth, Singapore
| | - Ni Luh Dewi
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia.
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4
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Xiang Y, Song J, Liang Y, Sun J, Zheng Z. Causal relationship between psychiatric traits and temporomandibular disorders: a bidirectional two-sample Mendelian randomization study. Clin Oral Investig 2023; 27:7513-7521. [PMID: 37907704 PMCID: PMC10713754 DOI: 10.1007/s00784-023-05339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
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.
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Affiliation(s)
- Yulin Xiang
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, Guizhou, China
| | - Jukun Song
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Guizhou Medical University, Guiyang, China
| | - Ying Liang
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, Guizhou, China
| | - Jiaxin Sun
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, Guizhou, China
| | - Zhijun Zheng
- School of Stomatology, Zunyi Medical University, Zunyi, China.
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, Guizhou, China.
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5
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Tervahauta E, Näpänkangas R, Närhi L, Tolvanen M, Pirttiniemi P, Silvola AS, Sipilä K. The relation of temporomandibular disorders with oral health-related quality of life in the Northern Finland Birth Cohort 1966. Cranio 2023:1-11. [PMID: 37343001 DOI: 10.1080/08869634.2023.2226829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between temporomandibular disorders (TMD) and oral health-related quality of life (OHRQoL) in an adult population. METHODS The data included 1,768 adults 46 years of age in the Northern Finland Birth Cohort 1966 (NFBC1966) study. The symptoms, signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and validated questionnaires. OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Associations of TMD and OHRQoL were evaluated with χ2 -test and Fisher's exact test. RESULTS In females, pain-related TMD signs and diagnoses associated significantly with prevalence of OHIP total and all dimensions, whereas in joint-related TMD, psychological dimensions showed the strongest association. Males with pain- or joint-related TMD, the most impaired dimension was physical pain. CONCLUSION Pain-related TMD seems to associate more strongly with lower OHRQoL than joint-related TMD especially in females.
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Affiliation(s)
- Elisa Tervahauta
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Ritva Näpänkangas
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Linnea Närhi
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Mimmi Tolvanen
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Pertti Pirttiniemi
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Anna-Sofia Silvola
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
| | - Kirsi Sipilä
- Department of Oral Development and Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu: Oulun Yliopisto, Oulu, Finland
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Emam ANM, Abdel-Gawwad EA, Baiomy AAA, Farhat MY, Atito E, Helal MA. Efficacy of Occlusal Splints and Low-Level Laser Therapy on the Mandibular Range of Motion in Subjects with Temporomandibular Joint Disc Displacement with Reduction. J Int Soc Prev Community Dent 2023; 13:229-236. [PMID: 37564171 PMCID: PMC10411297 DOI: 10.4103/jispcd.jispcd_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 08/12/2023] Open
Abstract
Aims and Objectives The study was carried out to evaluate the efficacy of four conservative therapeutic modalities on the mandibular range of motion (MRM) in subjects with anterior disc displacement with reduction (ADDwR) of the temporomandibular joint (TMJ). Materials and Methods One hundred patients (64 women and 36 men) were selected, and randomly distributed into four groups. Group I: Subjects receiving behavioral therapy (BT). Group II: Subjects receiving low-level laser therapy (LLLT). Group III: Subjects receiving maxillary anterior repositioning splint (MARS). Group IV: Subjects receiving stabilization splint (SS). The MRM was evaluated for each patient before treatment and after 6 months. Paired t test and one-way analysis of variance (ANOVA) tests were used for statistical analysis followed by a post hoc Tukey test (P ≤ 0.05). Results All groups showed significant improvement in MRM after 6 months of treatment (P ≤ 0.05) except for BT. There was a significant improvement for SS and MARS on the different movements of MRM, more than for LLLT and BT (P ≤ 0.05). Conclusion The MARS and the SS are effective in increasing the MRM for patients with ADDwR.
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Affiliation(s)
- Abdel-Naser M Emam
- Department of Prosthetic Dental Science, College of Dentistry, Najran University, Najran, Saudi Arabia
| | | | | | - Mostafa Yassin Farhat
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
| | - Ehap Atito
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
| | - Mohamed Ahmed Helal
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
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7
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Luo LY, Lee J, Li KY, Leung YY, Li DTS. Psychological Outcomes on Anxiety and Depression after Interventions for Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:653. [PMID: 36832144 PMCID: PMC9955945 DOI: 10.3390/diagnostics13040653] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023] Open
Abstract
Many studies have shown mutual interaction between temporomandibular disorders (TMD) and psychological distress. However, evidence on the effectiveness of therapeutic interventions for TMD on psychological outcomes is scarce. This review aimed to summarise the best evidence on the association between interventions for TMD and psychological outcomes regarding symptoms of anxiety and depression. Electronic search was carried out in databases, including Pubmed, Web of Science, Medline, Cochrane Library, and Scopus. All eligible studies were included for narrative synthesis. Eligible randomised controlled trials (RCTs) were included for the meta-analysis. The overall effect size of interventions for TMD was analysed in standardised mean difference (SMD) in levels of anxiety and depression. Ten studies were included in the systematic review. Of these, nine were included in the narrative analysis and four were included in the meta-analysis. All included studies and the result of the narrative analysis showed a statistically significant beneficial effect of interventions for TMD on improving symptoms of anxiety and depression (p < 0.0001); however, a statistically significant overall effect was not found in the meta-analyses. Current evidence is in favour of the interventions for TMD in improving symptoms of depression and anxiety. However, the effect is statistically uncertain and warrants future studies to enable the best synthesis of the evidence.
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Affiliation(s)
- Lai Ying Luo
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Johyun Lee
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Kar Yan Li
- Clinical Research Centre, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Dion Tik Shun Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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8
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Hietaharju M, Näpänkangas R, Ahtonen P, Kuoppala R, Sipilä K. The role of pain-related disability on treatment outcome and psychosocial symptoms in patients with temporomandibular disorders - a pilot study. Acta Odontol Scand 2023:1-6. [PMID: 36592379 DOI: 10.1080/00016357.2022.2162575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of the pilot study was to investigate the association of pain-related disability with the outcome of conservative treatment of temporomandibular disorders (TMD) and with depressive and non-specific physical symptoms among TMD pain patients utilizing Graded Chronic Pain Scale 1.0 (GCPS1.0) as a screening instrument. MATERIAL AND METHODS The study included 80 adult patients who were referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, due to TMD pain. At baseline, pain-related disability was assessed by using the GCPS1.0 according to the Research Diagnostic Criteria for TMD (RDC/TMD), and the patients were categorized into three TMD subtypes, 1-3. Patients were given conservative TMD treatment. At follow-up visits (1, 3, 6, and 12 months), patients evaluated the pain intensity on an NRS and described the treatment outcome and the severity of the TMD symptoms on a numerical scale. RESULTS AND CONCLUSIONS Patients with TMD subtype 3 (moderate/severe disability) had the highest NRS scores and described their symptoms as most severe at each time point, statistically significantly so at 1-month and 6-month follow-up (p < .05). The highest proportion of depressive symptoms was found in TMD subtype 3 (p < .05). The current pilot study showed that moderate/severe TMD-related disability, based on the GCPS 1.0 as a screening tool, may be linked with poor treatment outcome and depressive symptoms. Studies with larger samples are needed to confirm the results.
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Affiliation(s)
- Maria Hietaharju
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ritva Näpänkangas
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pinja Ahtonen
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ritva Kuoppala
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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9
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Wieckiewicz M, Jenca A, Seweryn P, Orzeszek S, Petrasova A, Grychowska N, Winocur-Arias O, Emodi-Perlman A, Kujawa K. Determination of pain intensity, pain-related disability, anxiety, depression, and perceived stress in Polish adults with temporomandibular disorders: A prospective cohort study. Front Integr Neurosci 2022; 16:1026781. [PMID: 36407294 PMCID: PMC9668250 DOI: 10.3389/fnint.2022.1026781] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
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].
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Affiliation(s)
- Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland,*Correspondence: Mieszko Wieckiewicz,
| | - Andrej Jenca
- Clinic of Stomatology and Maxillofacial Surgery, Faculty of Medicine, University Pavol Josef Šafárik and Akademia Košice, Košice, Slovakia
| | - Piotr Seweryn
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Sylwia Orzeszek
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Adriana Petrasova
- Clinic of Stomatology and Maxillofacial Surgery, Faculty of Medicine, University Pavol Josef Šafárik and Akademia Košice, Košice, Slovakia
| | - Natalia Grychowska
- Department of Dental Prosthetics, Wroclaw Medical University, Wroclaw, Poland
| | - Orit Winocur-Arias
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Krzysztof Kujawa
- Statistical Analysis Center, Wroclaw Medical University, Wroclaw, Poland
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10
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Prodoehl J, Kraus S, Buros Stein A. Predicting the number of physical therapy visits and patient satisfaction in individuals with temporomandibular disorder: A cohort study. J Oral Rehabil 2021; 49:22-36. [PMID: 34674278 DOI: 10.1111/joor.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMD) can be challenging to manage for clinicians and patients alike. It is unclear which factors are associated with prolonging conservative care and patient dissatisfaction with treatment outcomes. OBJECTIVES To examine factors collected during a physical therapy (PT) evaluation in a cohort of individuals with TMD to determine factors associated with an increased number of PT visits and reduced patient satisfaction. METHODS Records of 511 patients referred to PT over 18 months were reviewed to extract 27 variables to develop a predictive model. Outcomes were patient satisfaction following PT and number of PT visits. Linear and zero inflated negative binomial regressions were used, and a multivariate regression model was built for both outcomes. RESULTS Two factors were associated with both lower patient satisfaction and an increased number of PT visits: higher patient rated functional neck disability and a greater number of healthcare professionals seen. Other factors associated with patient satisfaction were duration of symptoms, subluxation, and referral from an oral surgeon. Only patient rated functional neck disability score was a significant predictive factor in the multivariate model. Factors associated with number of PT visits were gender, educational level, time between initial visit and discharge, number of pain areas, bruxism, biopsychosocial factors, dizziness, pain rating, and presence of neck pain. In the multivariate model, gender, number of healthcare professionals seen, and resting pain rating were significant predictors of number of PT visits. CONCLUSION Considering key factors on initial evaluation, specifically functional neck disability and the number of prior healthcare professionals seen before starting PT, can help to predict a higher number of PT visits and reduced patient satisfaction with outcomes.
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Affiliation(s)
- Janey Prodoehl
- Physical Therapy Program, Midwestern University, Downers Grove, Illinois, USA
| | - Steven Kraus
- Horizon Physical Therapy LLC, Atlanta, Georgia, USA
| | - Amy Buros Stein
- Office of Research and Sponsored Programs, Midwestern University, Glendale, Arizona, USA
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11
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Häggman-Henrikson B, M Visscher C, Wänman A, Ljótsson B, C Peck C, Lövgren A. Even mild catastrophic thinking is related to pain intensity in individuals with painful temporomandibular disorders. J Oral Rehabil 2021; 48:1193-1200. [PMID: 34462940 DOI: 10.1111/joor.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/28/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
AIMS Temporomandibular disorders (TMD) are often associated with psychological comorbidities. One such comorbidity is pain catastrophising, that is, exaggeration of negative consequences of a painful event. The aim was to investigate catastrophising in individuals with painful TMD compared to controls and the association between catastrophising and pain intensity, number of pain sites and functional limitations. METHODS A community-based sample of 110 individuals (83 women; 20-69 yrs) with painful TMDs (myalgia/arthralgia as per Diagnostic Criteria for TMD) and 190 age- and gender-matched controls (119 women; 20-69 yrs) from the Public Dental services in Västerbotten, Sweden, participated. Associations between catastrophising and functional jaw limitations, respectively, and painful TMD were evaluated with ordinal regression adjusted for the effect of gender and age. Associations (Spearman's correlation) of the Pain catastrophising Scale (PCS) with Jaw Functional Limitation Scale (JFLS-20), pain site number (whole-body pain map), and characteristic pain intensity (CPI) and intergroup comparisons (Mann-Whitney U test) of these variables were also calculated. RESULTS Levels of catastrophising were associated with TMD pain (OR 1.6, 95%CI 1.1-2.6). Among individuals with painful TMD, catastrophising was correlated to pain intensity (r=0.458, p<0.01) and functional limitations (r=0.294-0.321, p≤0.002), but not to number of pain sites. CONCLUSION Compared to controls, community-based individuals with painful TMD demonstrated higher levels of pain catastrophising, and this catastrophising was associated with increased pain intensity and jaw dysfunction. The relatively low scores of pain catastrophising suggest that even mild catastrophic thinking is associated with pain perception and jaw function, and should be considered in patient management.
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Affiliation(s)
- Birgitta Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.,Department of Odontology/Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Anders Wänman
- Department of Odontology/Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Christopher C Peck
- The University of Sydney Westmead Initiative, The University of Sydney, Sydney, Australia
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Umeå University, Umeå, Sweden
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12
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Huhtela OS, Näpänkangas R, Suominen AL, Karppinen J, Kunttu K, Sipilä K. Association of psychological distress and widespread pain with sympatoms of temporomandibular disorders and self-reported bruxism in students. Clin Exp Dent Res 2021; 7:1154-1166. [PMID: 34289266 PMCID: PMC8638324 DOI: 10.1002/cre2.472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/10/2021] [Accepted: 06/25/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The aim of this study was to evaluate the association of psychosocial distress and widespread pain with self‐reported symptoms of temporomandibular disorders (TMD) and bruxism, in two cross‐sectional surveys in 2012 and 2016, and whether there are temporal changes in the magnitude of associations. Materials and methods The data were gathered from Finnish university students in 2012 and 2016. TMD symptoms were assessed with three validated questions and bruxism with one frequently used question. Psychosocial distress was assessed with the General Health Questionnaire‐12 (GHQ‐12), and widespread pain with questions of pain in the extremities, the neck or upper back, and lower back. The associations of GHQ‐12, widespread pain and background variables with TMD symptoms and bruxism were analyzed with chi‐square tests, t‐test and binary logistic regression models stratified by gender, and adjusted for age‐group, self‐reported general health/wellbeing and presence of widespread pain. Results Higher GHQ‐12 score and presence of widespread pain were significantly associated with TMD symptoms in both genders at both time points. The association of higher GHQ‐12 score with sleep bruxism and awake bruxism were inconsistent. In the adjusted model higher GHQ‐12 score and widespread pain were significantly related to TMD pain symptoms in both genders at both time points, and to bruxism in 2012. Between the two time points a greater variability in these associations was seen in men than in women. Conclusions Psychological distress and widespread pain are significant determinants in perceived TMD pain and bruxism among students. No significant temporal alterations were observed.
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Affiliation(s)
- Outi S Huhtela
- University of Eastern Finland - Kuopio campus, Institute of Dentistry, Kuopio, Finland.,Faculty of Medicine, Research Unit of Oral Health Sciences, Oulu University, Oulu, Finland
| | - Ritva Näpänkangas
- Faculty of Medicine, Research Unit of Oral Health Sciences, Oulu University, Oulu, Finland.,Medical Research Center, Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland
| | - Anna Liisa Suominen
- University of Eastern Finland - Kuopio campus, Institute of Dentistry, Kuopio, Finland
| | - Jaro Karppinen
- Medical Research Center, Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland.,Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Kirsi Sipilä
- Faculty of Medicine, Research Unit of Oral Health Sciences, Oulu University, Oulu, Finland.,Medical Research Center, Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland
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13
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Tanhan A, Ozer AY, Polat MG. Efficacy of different combinations of physiotherapy techniques compared to exercise and patient education in temporomandibular disorders: A randomized controlled study. Cranio 2021:1-13. [PMID: 33818314 DOI: 10.1080/08869634.2021.1909454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Abdurrahman Tanhan
- Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Aysel Yildiz Ozer
- Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Mine Gulden Polat
- Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
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14
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Günther T, Schierz O, Hahnel S, Rauch A. Field-testing a psychosocial assessment scoring form for TMD patients - summarizing axis II instruments. BMC Oral Health 2020; 20:267. [PMID: 32998738 PMCID: PMC7528229 DOI: 10.1186/s12903-020-01248-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background The etiology of temporomandibular disorders (TMD) can be explained on the basis of a biopsychosocial model. However, psychosocial assessment is challenging in daily dental practice. The purpose of the current study was to field-test the practicability of a novel psychosocial assessment scoring form regarding the reliability of scoring procedures and the opinion of examiners. The working hypotheses were that the scoring results of inexperienced undergraduate students were similar to the results collected by a gold standard and that the scoring form was easy to use. Methods A psychosocial assessment scoring form was developed in accordance with guidelines of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), including results of the Graded Chronic Pain Scale (GCPS), Patient Health Questionnaires (PHQ), and Generalized Anxiety Disorders (GAD). Inexperienced operators (undergraduate students) examined patients with TMD-associated complaints and rated the practicability of the scoring form. The scoring results were recalculated by two experienced operators and a consensus was defined as a gold standard. Reliability coefficients were determined comparing results of the gold standard and the inexperienced operators. Results Sixty-five examiners used the scoring form to obtain results for patients with TMD-associated complaints. Of the patients, 78.8% received a diagnosis according to DC/TMD decision trees. Two-thirds of the operators (62.9%) stated that the form was easy to complete, and 83.0% would use it in their dental practice. The reliability coefficients ranged between 0.81–1.00. Conclusions Within the limitations of the present study, the psychosocial assessment scoring form seems to be an easy-to-use and practicable tool. The vast majority of the inexperienced examiners recommended the application.
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Affiliation(s)
- Tamara Günther
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Oliver Schierz
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Sebastian Hahnel
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Angelika Rauch
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
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15
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Wang Y, Zhao Y, Yang G, Xie Q. Assessment of somatosensory changes in Chinese temporomandibular disorders arthralgia patients by quantitative sensory testing. J Oral Rehabil 2020; 47:1129-1141. [PMID: 32589802 DOI: 10.1111/joor.13038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Somatosensory changes in Chinese temporomandibular disorders (TMD) arthralgia patients have not been fully studied by the latest technologies. OBJECTIVE This study aims at assessing somatosensory changes in Chinese TMD arthralgia patients quantitatively. METHODS Standardised quantitative sensory testing (QST) was performed on the pain sites and contralateral sites of 40 patients diagnosed with TMD arthralgia according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) before and after medication; similar measures were taken in 40 age- and gender-matched healthy controls. Differences within and between groups were assessed through Z-scores, two-way ANOVA and loss/gain coding system. RESULTS The pain sites of patients presented increased sensitivity to thermal stimuli and mechanical pain stimuli together with decreased sensitivity to mechanical tactile stimuli before medication (P < .001). Before treatment, 100% of patients had somatosensory abnormalities at the pain sites; the most frequent abnormalities were somatosensory gain to cold nociceptive, pinprick and pressure stimuli, and the most frequent loss/gain score was L0G3 (no somatosensory loss with a gain of thermal and mechanical somatosensory function; 70.0%). After treatment, although the clinical symptoms and signs of 40 patients disappeared, 80.0% of the patients' pain sites still showed multiple phenotype abnormalities. The most frequent loss/gain score was L0G2 (no somatosensory loss with a gain of mechanical somatosensory function; 35.0%). CONCLUSIONS Multiple phenotypes of facial somatosensory abnormalities were detected in Chinese TMD arthralgia patients before and after treatment, despite the disappearance of clinical signs and symptoms. Individual variations indicate a possible need for subgroup classification, individualised management and mechanism-based treatment.
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Affiliation(s)
- Yang Wang
- First Clinical Division and Center for Oral Function Diagnosis, Treatment and Research, Peking University School & Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yanping Zhao
- Center for TMD and Orofacial Pain, Peking University School & Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Guangju Yang
- Department of Prosthodontics and Center for Oral Function Diagnosis, Treatment and Research, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Qiufei Xie
- Department of Prosthodontics and Center for Oral Function Diagnosis, Treatment and Research, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
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16
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Kiviahde H, Silvola AS, Pesonen P, Sipilä K, Raustia A, Pirttiniemi P. Occlusal characteristics in facial pain cases and controls - 12-year follow-up of the Northern Finland Birth Cohort (NFBC) 1966. Cranio 2020; 40:394-400. [PMID: 32223549 DOI: 10.1080/08869634.2020.1745499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The purpose of this study was to investigate the occlusal characteristics in Finnish adults at 12-year follow-up based on the Northern Finland Birth Cohort 1966 (NFBC1966) subjects.Methods: The occlusal analyses were performed at ages 34 and 46 years of facial pain cases (n = 52) and controls (n = 49) by two different methods.Results: At 12-year follow-up, a significant decrease in upper anterior segment peer assessment rating (PAR) score was found in the controls, indicating improvement in teeth alignment. In facial pain cases, left lateral occlusal relationship and midline asymmetry were significantly decreased. Occlusal asymmetry and overjet were significantly increased. In controls, the left canine showed a more normal occlusal relationship, cuspid asymmetry was changed, and midline asymmetry was significantly decreased.Conclusion: During a 2-year period, occlusal asymmetry and overjet increased significantly in facial pain cases, while occlusal relationship showed more normal characteristics in controls.
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Affiliation(s)
- Heikki Kiviahde
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anna-Sofia Silvola
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Paula Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aune Raustia
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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