Factors associated with signs of temporomandibular pain: an 11-year-follow-up study on Finnish adults

Statistical Methods and Machine Learning Algorithms for Investigating Metabolic Syndrome in Temporomandibular Disorders: A Nationwide Study

The objective of this study was to analyze the associations between temporomandibular disorders (TMDs) and metabolic syndrome (MetS) components, consequences, and related conditions. This research analyzed data from the Dental, Oral, Medical Epidemiological (DOME) records-based study which integrated comprehensive socio-demographic, medical, and dental databases from a nationwide sample of dental attendees aged 18-50 years at military dental clinics for 1 year. Statistical and machine learning models were performed with TMDs as the dependent variable. The independent variables included age, sex, smoking, each of the MetS components, and consequences and related conditions, including hypertension, hyperlipidemia, diabetes, impaired glucose tolerance (IGT), obesity, cardiac disease, obstructive sleep apnea (OSA), nonalcoholic fatty liver disease (NAFLD), transient ischemic attack (TIA), stroke, deep venous thrombosis (DVT), and anemia. The study included 132,529 subjects, of which 1899 (1.43%) had been diagnosed with TMDs. The following parameters retained a statistically significant positive association with TMDs in the multivariable binary logistic regression analysis: female sex [OR = 2.65 (2.41-2.93)], anemia [OR = 1.69 (1.48-1.93)], and age [OR = 1.07 (1.06-1.08)]. Features importance generated by the XGBoost machine learning algorithm ranked the significance of the features with TMDs (the target variable) as follows: sex was ranked first followed by age (second), anemia (third), hypertension (fourth), and smoking (fifth). Metabolic morbidity and anemia should be included in the systemic evaluation of TMD patients.

Primary headaches in scuba divers and the effect of temporomandibular dysfunction

OBJECTIVE

This study aimed to evaluate the frequency of episodic primary headaches (EPH) and temporomandibular dysfunction's (TMD) effect in experienced scuba divers.

METHODS

A form consisting of the Fonseca Anamnestic Index and a structured headache questionnaire was sent to individuals using social media platforms.

RESULTS

A total of 132 divers and 104 non-divers were included the study. In male divers, EPH and TMD were not different from the non-diver group (p = 0.1, p = 0.1), and TMD had an effect on increasing the possibility of migraine (OR = 2.5, p = 0.04). In female divers, the possibility of EPH and TMD were also lower (OR = 0.1, p < 0.001, OR = 0.2, p = 0.01).

CONCLUSION

Scuba diving does not pose a risk for EPH or TMD in either gender. TMD treatment in male divers is important for uncontrolled migraine attacks.

Efficiency of occlusal splint therapy on orofacial muscle pain reduction: a systematic review

BACKGROUND

This systematic review aims to examine the existing original studies to determine the effectiveness of occlusal splints (OSs) in the management of orofacial myalgia and myofascial pain (MP) in comparison with no treatment or other interventions.

MATERIALS AND METHODS

Based on the inclusion and exclusion criteria of this systematic review, randomized controlled trials were qualified, in which the effectiveness of occlusal splint therapy in the management of muscle pain was examined in comparison with no treatment or other interventions. This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The authors searched three databases (PubMed, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and Scopus) for English publications published between January 1, 2010, and June 1, 2022. The last database search was carried out on June 4, 2022. Data were extracted from the included studies and assessed for risk of bias using the revised Cochrane risk-of-bias tool for randomized trials.

RESULTS

Thirteen studies were identified for inclusion in this review. In total, 589 patients were diagnosed with orofacial muscle pain who underwent education and various forms of therapy including different types of OSs, light emitting diode therapy, acupuncture, low-level laser therapy, device-supported sensorimotor training, Kinesio Taping, myofunctional therapy, and physical therapy. All studies included demonstrated a high risk of bias.

CONCLUSIONS

There is insufficient evidence regarding whether OS therapy in the treatment of orofacial myalgia and MP offers an advantage over other forms of interventions or no treatment. Further reliable clinical studies in this area are needed to improve the quality of research, which should be performed with larger groups of blinded respondents and controls.

CLINICAL RELEVANCE

Due to the large-scale nature of orofacial muscle pain, it is assumed that each dental clinician will meet patients with orofacial muscle pain repeatedly in daily practice; hence, the review of the effectiveness of OSs in the management of orofacial myalgia and MP is necessary.

Association between cynical hostility and temporomandibular pain mediated through somatization and depression: an 11-year follow-up study on Finnish adults

BACKGROUND

Hostility is believed to have an adverse effect on physical health through mediating psychosocial factors.

OBJECTIVES

This study aimed to investigate the association of hostility with temporomandibular (TMD) pain. Another aim was to investigate if the association is mediated through increases in depressiveness and somatization in an 11-year follow-up on Finnish adults, based on the Health 2000 and 2011 Surveys (BRIF8901).

MATERIAL AND METHODS

The sample comprised subjects who underwent clinical TMD pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TMD pain symptoms in 2011. Hostility was measured using the Cynical Distrust Scale, somatization was measured using the Symptom Checklist-90, and depressiveness using Beck's Depression Inventory-21. Four subgroups were formed based on the presence of TMD pain: no pain, pain in 2000 only, pain in 2011 only, and pain in 2000 and 2011. Analyses included chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hostility in 2000 as the predictor. Mediation analysis was performed using Hayes' Process v3.5.

RESULTS

Those with higher hostility showed a higher prevalence of TMD pain. Longitudinally, the association of hostility with TMD pain in 2000 only, and with TMD pain in both years, was mediated either by somatization only or by depressiveness that was mediated by somatization. In those with TMD pain in 2011 only, the association was mediated by depressiveness that was mediated by somatization.

CONCLUSION

Hostility increased the risk of TMD pain through increases in depressiveness and somatization.

Painful and non-painful comorbidities associated with short- and long-term painful temporomandibular disorders: A cross-sectional study among adolescents from Brazil, Canada, and France

BACKGROUND

Temporomandibular disorder (TMD) pain is common among adolescents. The association between painful TMD and other comorbidities has been demonstrated. However, the difference between short-term (<6 months) and long-term (≥ 6 months) painful TMD is not yet clear.

OBJECTIVE

The aim of this study was to assess the association between comorbidities and short- and long-term painful TMD among adolescents.

METHODS

In this cross-sectional study, adolescents were recruited from Montreal (Canada), Nice (France), and Arceburgo (Brazil). Self-reported painful TMD, comorbidities, school absence, and analgesic intake were assessed using reliable instruments. Multivariable logistic regression analyses were conducted to assess the study aims.

RESULTS

The prevalence of short- and long-term painful TMD was estimated at 22.29% and 9.93%, respectively. The number of comorbidities was associated with short- (OR = 1.71, 95%CI = 1.53-1.90) and long-term painful TMD (OR = 1.79, 95%CI = 1.55-2.08) compared to controls. Frequent headaches (OR_short-term = 4.39, 95%CI = 3.23-5.98, OR_long-term = 3.69, 95%CI = 2.45-5.57) and back pain (OR_short-term = 1.46, 95%CI=1.06-2.03, OR_long-term  = 1.69, 95%CI = 1.11-2.59) were associated with both painful TMD groups. Frequent neck pain (OR = 2.23, 95%CI = 1.53-3.26) and allergies were only associated with short-term painful TMD (OR = 1.54, 95%CI = 1.13-2.10). Frequent stomach pain was related to long-term (OR = 2.01, 95%CI = 1.35-3.26), and it was the only comorbidity significantly more frequent among the long than short-term TMD (OR = 1.82, 95%CI: 1.14-2.90). These analyses were adjusted by sex, age, and city.

CONCLUSION

In this multi-center study, both short- and long-term painful TMD are associated with frequent headaches and back pain, whereas frequent neck pain and allergies are related to only short-term, and frequent stomach pain with long-term painful TMD.

Low-grade inflammation as a potential mediator between depressive symptoms and temporomandibular pain: an 11-year follow-up study on Finnish adults

BACKGROUND

Low-grade inflammation and depressiveness have been associated with chronic pain conditions.

OBJECTIVE

To examine whether low-grade inflammation mediates the association between depressive symptoms and temporomandibular (TM) pain in Finnish adults based on the Health 2000/2011 Surveys (BRIF8901).

METHODS

The sample comprised subjects who underwent clinical TM pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TM pain symptoms in 2011. The serum level of hs-CRP was obtained in both years, and depressiveness was assessed using the Beck Depression Inventory-21 (BDI-21) in 2000 and BDI-13 in 2011. Four subgroups were formed based on the presence of TM pain: No pain, pain in 2000-only, pain in the 2011-only, and pain in both-years. Analyses included Rao Scott's chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hs-CRP and BDI-21 score in 2000 as predictors. Mediation was tested using Hayes A. Processv3.5.

RESULTS

Higher BDI-21/-13 and hs-CRP levels corresponded to higher prevalences of TM pain in both years. Longitudinally, in men, higher hs-CRP level predicted TM pain in 2000-only and TM pain in both-years. Higher BDI-21 score predicted having TM pain in 2011-only. In women, higher BDI-21 score predicted TM pain in 2000-only and having TM pain in both-years. Both BDI-21 and hs-CRP had a direct effect on TM pain outcome with no mediation detected.

CONCLUSION

While depressiveness may increase the risk of chronic TM pain in women, the risk in men is increased by low-grade inflammation.

Association of Temporomandibular Disorder Symptoms with Physical Fitness among Finnish Conscripts

Studies on the role of physical fitness, physical activity and obesity as risk factors for temporomandibular disorders (TMD) are scarce. The aim of the present study was to evaluate the association of TMD symptoms with physical fitness, physical activity and body mass index (BMI) among Finnish conscripts. The study sample consisted of 8685 Finnish conscripts. Data on self-reported TMD symptoms were used as outcome variables. Physical activity (questionnaire), physical fitness (measured with physical tests: Cooper test, push-ups, sit-ups and standing long jump) and body mass index (BMI) were used as explanatory variables. The associations between TMD symptoms and explanatory variables were evaluated using Chi-squared test and logistic regression analysis. The prevalence of all TMD symptoms was significantly higher among those who exercised more rarely than weekly. Pain-related TMD symptoms were also significantly more frequent among those who were overweight (BMI ≥ 25). Poor push-up results and overweight (BMI ≥ 25) were significantly associated with jaw pain and TMJ pain at jaw rest. The present study showed that good physical fitness may be a protective factor against TMD pain. Dentists should also be prepared to motivate TMD patients to physical activity and regular exercise as part of the treatment.

Efficacy of occlusal splints in the treatment of temporomandibular disorders: a systematic review of randomized controlled trials

OBJECTIVE

This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs).

MATERIAL AND METHODS

This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four databases (Medline via Pubmed, Web of Science, Embase and Scopus) were searched, the last search was conducted on April 2020. Randomised controlled trials (RCTs) employing the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as diagnostic criteria and including occlusal splint as one of the experimental groups were included in the present study. The data from the included studies were extracted and assessed for risk of bias.

RESULTS

Eleven studies were included. The sample size ranged from 12 to 96 subjects. The male to female ratio was 0 to 25%. The mean length of follow-up was 4 months. Occlusal splint had a positive effect on mandibular movements in all included studies. Seven studies showed a positive effect of occlusal splint on chronic pain reduction and pain intensity, while two others showed improvement of temporomandibular joint clicking sounds and locking of the jaws. Moreover, improvements in mouth opening, depression, and anxiety symptoms, were reported in four studies.

CONCLUSIONS

An occlusal splint can be considered as a non-invasive treatment approach for patients with TMD, especially those with signs and symptoms of restriction of mandibular movement and pain. Moreover, the present findings highlighted an urgent need of a standardised consensus regarding the prognostic evaluation of TMD.

Development and internal validation of prediction models for persistence of self-reported orofacial pain in the follow-up of patients with myofascial pain

Objectives

To identify predictors in patient profiles, and to develop, internally validate, and calibrate prediction models for the persistence of self-reported orofacial pain at the 6-month and 12-month follow-up in patients with myofascial pain.

Materials and methods

A cohort of 63 adult patients with moderate to severe chronic myofascial pain was included. Patient and disease characteristics at baseline were recorded as potential predictors. Patients` presence or absence of improvement of orofacial pain at follow-up was considered the outcome. Binary logistic regression analyses were used to develop the models. The performance and clinical values of the models were determined.

Results

Forty-three percent and 30% of the patients had persistence of orofacial pain at 6-month and 12-month follow-up, respectively. Pain elsewhere, depression, parafunctional activities, and mandibular function impairment (MFI) were significantly associated with persistence of the pain at 6-month follow-up, whereas depression, parafunctional activities, and MFI were significantly associated with persistence of the pain at 12-month follow-up. Both of the models showed good calibration and discrimination, with shrunken area under the curve (AUC) values of 0.73 and 0.76, respectively. The clinical added predictive values for ruling in the risk of the persistence were 0.30 and 0.31, respectively, and those for ruling it out were 0.25 and 0.20, respectively.

Conclusions

Potential predictors for prediction of the persistence of self-reported orofacial pain at follow-up were identified. The calibration, discrimination, and clinical values of the models were acceptable.

Clinical relevance

The models may assist clinicians in decision-making regarding the improvement of orofacial pain of individual patients during follow-up in clinical settings.

Does adolescent self-reported TMD pain persist into early adulthood? A longitudinal study

Objective: To follow up 2209 individuals in a longitudinal study and assess self-reported TMD pain, painful and non-painful comorbid conditions, and pain-related disability.Material and methods: During 2012-2014, questionnaires were sent to 2209 eligible individuals who had been screened for TMD pain each year during 2000-2003. The two screening questions were (1) Do you have pain in the temple, face, jaw joint, or jaws once a week or more often? and (2) Do you have pain when you open your mouth wide or chew once a week or more often? If the patient answered 'yes' to one or both of the questions, TMD pain was recorded. Non-respondents received reminders; telephone interviews were offered a randomised group. The questionnaire queried TMD pain, and painful and non-painful comorbid conditions.Results: The overall response rate was 36.5%. Individuals were placed into one of four pain groups defined by their pain experience at baseline and at the follow-up: no TMD pain (69.0%), new TMD pain (13.0%), previous TMD pain (9.9%), and persistent TMD pain (8.1%). Based on the self-report surveys, significantly more responders with TMD pain at follow-up had had pain as adolescents than not. Of adolescents with TMD pain, 45.1% had pain at follow-up as young adults, while 15.8% had pain at follow-up without a previous history of TMD pain. Individuals with persistent TMD pain had high frequencies of comorbid pains (p < .001), 45.2% reported moderate-severe depression scores (p < .001), and 13.0% had moderate pain-related disability (GCPS).Conclusions: Based on self-report surveys, TMD pain in adolescence appears to triple the risk of TMD pain in young adulthood, and persistent pain increased comorbid pain and psychosocial distress.

Physical activity level and temporomandibular disorders in South Koreans

OBJECTIVE

This study aimed to investigate the association between general physical activity level and TMD pain in Koreans in a large-scale national database established through a nationwide survey.

METHODS

Data from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), which was conducted from 2007 to 2009, were analysed. In total, 16 941 participants were included in this cross-sectional study. Data on sociodemographic characteristics, TMD-related variables, and general physical activity level were collected. Participants were divided into moderate- and low-intensity exercise groups according to their physical activity levels. Multivariate logistic regression analyses were performed, adjusting for sociodemographic and other covariates.

RESULTS

The adjusted odds ratio (OR) (95% confidence interval; CI) for TMD pain was 1.373 (1.017-1.854) for people doing moderate-intensity exercises and 0.797 (0.629-1.008) among people doing low-intensity exercises. Those who did moderate-intensity exercises had significantly more TMD pain. This was higher in the 30- to 39-year age group (OR: 1.991, 95% CI: 1.137-3.488), with significantly higher risk for TMD pain in those who did moderate-intensity exercise, whereas low-intensity exercise significantly decreased the risk for TMD pain in the same age group (OR: 0.625, 95% CI: 0.409-0.958).

CONCLUSIONS

Moderate-intensity physical activity is associated with more TMD pain. Patients with TMD should avoid high-intensity level exercises and continue low-intensity exercises to prevent pain aggravation.