Associations between symptoms of temporomandibular disorders, quality of life and psychological states in Asian Military Personnel

Custo-Efetividade de Diferentes Tratamentos Minimamente Invasivos Para Disfunção Temporomandibular de Origem Articular sob a Perspectiva do Sistema Público de Saúde Brasileiro

OBJECTIVE

This study aimed to evaluate the cost-effectiveness (CE) of minimally invasive interventions for pain associated with articular temporomandibular dysfunction from the Brazilian Public Health System (SUS) perspective.

METHODS

This is a CE study with a 1-year time horizon. Effectiveness data were extracted from a network meta-analysis, and 2 treatments with moderate levels of evidence certainty were evaluated: arthrocentesis (ARTRO) plus intra-articular corticosteroid (CO) injection and ARTRO plus intra-articular injection of sodium hyaluronate (SH). For CE analysis, the costs of 2 types of SH (low and high molecular weight) and 4 COs (betamethasone [B], dexamethasone acetate [D], methylprednisolone sodium succinate [M], or triamcinolone hexacetonide [T]) were considered. Modeling was conducted using TreeAge Pro Healthcare software, with the construction of a decision tree representing a hypothetical cohort of adults with articular temporomandibular dysfunction. Deterministic and probabilistic sensitivity analyses were performed. In addition, an acceptability curve was developed.

RESULTS

The total costs per joint for ARTRO plus low- and high-molecular-weight SH and ARTRO plus COs B, D, M, and T were, respectively, R$583.32, R$763.85, R$164.39, R$133.93, R$138.57, and R$159.86. ARTRO plus dexamethasone acetate was considered cost-effective, with lower cost and higher net monetary benefit than other technologies. In all sensitivity analysis scenarios, it remained cost-effective. It also showed greater acceptability.

CONCLUSION

ARTRO plus dexamethasone acetate was considered the cost-effective technology, exhibiting higher net monetary benefit and higher acceptability from the SUS perspective.

Prevalence of temporomandibular disorders and their associated factors in Confucian heritage cultures: A systematic review and meta-analysis

BACKGROUND

Temporomandibular disorders (TMDs) may be an 'idiom' of psychological distress in Confucian heritage cultures (CHCs).

OBJECTIVES

This systematic review/meta-analysis estimated the prevalence of TMDs in CHCs and compared the differences in TMD occurrence between time periods and age groups. Additionally, the associated biopsychosocial risk factors were also examined.

METHODS

The study protocol was developed a priori following the PRISMA guidelines and Joanna Briggs Institute systematic review methodology (CRD42021245526). Electronic searches of seven databases were conducted from January 2002 to Dec 2021. Reference lists of identified studies were hand-searched for additional articles. Study selection, quality assessment, and data extraction were done. Meta-analysis was performed using the RevMan 5.4 software.

RESULTS

Forty-eight articles were included in the systematic review. Overall prevalences were: TMDs-15% (95% CI: 15-16%); TMD pain-8% (95% CI: 7-9%); TMJ sounds-24% (95% CI: 21-27%); and TMJ locking-7% (95% CI: 1-13%). While TMD prevalence appeared to have declined from 2002 to 2011 to 2012-2021, the occurrence of TMD pain, TMJ sounds, and locking increased marginally or remained constant. TMD prevalence in children/adolescents was 18% (95% CI: 14-22%) and 17% (95% CI: 16-18%) among adults. Significant associations between TMDs and bruxism/psychological distress/education levels were specified by 73%/90%/88% of the relevant studies.

CONCLUSIONS

TMDs are prevalent in CHCs and a slight increase in TMD pain (2%) and TMJ sounds (8%) were discerned over the past two decades. TMDs are related to a myriad of biopsychosocial variables, particularly psychological distress, and these factors must be addressed within the cultural context of patients.

Cross-Cultural Validation of the Thai Oral Health Impact Profile for Temporomandibular Disorders

OBJECTIVES

The Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMDs) is a validated condition-specific outcome measure to help guide decision-making in the management of the condition. There is no Thai version of OHIP-TMDs, and therefore the original English version needs cross-cultural adaptation translation, and validation with a Thai population to reduce the anomalies due to language and cultural differences. This study aimed to develop the Thai-language version of OHIP-TMDs, perform a cross-cultural adaptation to Thailand, and assess its content validity, internal consistency, reliability, and construct validity.

METHODS

The original English version of OHIP-TMDs was forward and backward translated into Thai language using the International Network for Orofacial Pain and Related Disorders methodology (INfORM) protocol for cross-cultural adaptation. The Content Validity Index (CVI) was performed by 5 orofacial pain (OFP) specialists to establish content validity. The OHIP-TMDs-T was then tested in 2 groups of Thai dental patients including 110 TMD patients and 110 control participants. The internal reliability and test-retest reliability (n = 30) were investigated in the TMD group using Cronbach alpha coefficient and intraclass correlation coefficient (2-way mixed effect model), respectively. The difference in OHIP-TMDs-T score between the TMD group and control group was investigated for known group validity.

RESULTS

Cronbach alpha and intraclass correlation coefficients were 0.942 and 0.797, respectively. The CVI collected from the OFP specialists was 0.92. There was a statistical difference in the OHIP-TMDs-T overall score between the TMD group (95% CI, 40-46) and control group (95% CI, 2.0-3.4) (Z = 9.060, r = 1, P < .001).

CONCLUSIONS

The OHIP-TMDs-T is a valid and reliable tool for evaluating the quality of life and the impact on oral health in Thai patients with TMD.

Oral habits and temporomandibular joint disorders according to stress levels among military personnel in South Korea: A cross-sectional study

BACKGROUND

Military personnel suffer from stress-induced temporomandibular joint disorders (TMD). No previous studies have evaluated the oral habits and TMD in military personnel based on their stress levels.

OBJECTIVES

To examine the correlation between oral habits and TMD based on stress levels. In addition, we assessed the relationship between stress levels and TMD by military rank as well as the impact of oral habits on TMD.

METHOD

This cross-sectional survey included 89 military personnel who visited the Armed Forces Medical Center in Korea with discomfort in the temporomandibular joint (TMJ) discomfort. Oral habits, stress level, TMD and general characteristics of the subjects were investigated. A questionnaire was distributed to the subjects who agreed to the study, and they were asked to respond in a self-written form. Multiple linear regression analysis was performed to examine the factors that affect oral habits and TMJ symptoms.

RESULTS

Stress scores and oral habits were highest in the 'Private' rank. In contrast, temporomandibular joint symptoms were highest in the 'Corporal' rank. Additionally, the high-risk stress group exhibited higher scores in oral habits and TMD compared to the potential stress group. Furthermore, there was a positive correlation between an increase in high-risk stress scores and a rise in oral habits. And individuals with more oral habits are at an increased likelihood of experiencing TMD.

CONCLUSION

Our study findings suggest that military personnel with prevent TMD and improve oral habits by addressing stress levels.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Oral health quality of life is associated to jaw function and depression in patients with myogenous temporomandibular dysfunction

OBJECTIVE

To determine which factors influence and better differentiate between good and poor oral health-related quality of life (OHRQoL) in patients with myogenous TMD and which cut-off could predict a good/poor OHRQoL.

METHODS

Fifty-eight women with myogenous TMD were included. Factors of interest were collected (i.e., demographic variables, depression symptoms (Symptom Checklist-90 R (RDC/TMD)), pain intensity (Visual Analog Scale), jaw function (Mandibular Functional Limitation Questionnaire), and OHRQoL (Oral Health Impact Profile-14). A multivariable regression model, logistic regression, and receiver operating curve (ROC) analyses were conducted.

RESULTS

Depression symptoms (β = 0.139) and jaw function (β = 0.478) were significantly associated with OHRQoL in the multivariable model. The best model to discriminate between good/poor OHRQoL included only jaw function (AUC = 0.90), with the best cut-off of 17 points (sensitivity: 0.93; specificity: 0.79).

CONCLUSION

Depression symptoms and jaw function were significantly associated with OHRQoL. The best model and cut-off to discriminate good/poor OHRQoL included only jaw function.

A pilot study of the depression, anxiety and stress in Greek military personnel during the first year of the COVID-19 pandemic

INTRODUCTION

The ongoing SARS-CoV-2 pandemic is a global health crisis which poses many psychological research challenges. The objective of this study was to evaluate the responsiveness and validity of depression, anxiety and stress in a representative cohort of Hellenic military personnel using the short version of the Greek military version of the Depression-Anxiety-Stress Scales-21 (DASS-21) questionnaire.

METHODS

A total of 158 participants were voluntarily surveyed using an electronically developed structured questionnaire. The anonymous e-questionnaire included a social demographic section and the DASS-21 scale section. It was distributed in September 2020 to the military personnel of the Hellenic Tactical Air Force Units using an intranet network during government restrictive measures due to the COVID-19 crisis.

RESULTS

Our DASS-21 survey indicated a positive outcome at the psychometric level of our military sample population. Age, sex and systemic medications were statistically correlated with anxiety. Inter-correlations between the DASS-21 statements showed that individuals with low-level depression also experienced some degree of stress. Factor analysis indicated the reliability and validity of the questionnaire.

CONCLUSIONS

The low levels of depression and stress among our military sample population demonstrate the importance of periodic monitoring of the psychometric items of the DASS-21 subscales to design and implement psychological prevention strategies, especially during the ongoing and future healthcare crises.

Correlation Between the Prevalence of Temporomandibular Disorders and Their Association With Psychological Distress in Central Saudi Arabia

Background In this study, we aimed to determine the prevalence of temporomandibular disorders (TMDs) and their association with psychological distress in the central region of Saudi Arabia. Methodology In this cross-sectional study, a questionnaire was sent randomly to residents of Al-Qassim province. They were asked to complete a TMD pain screener, the Patient Health Questionnaire-4 (PHQ-4), and the Generalized Anxiety Disorder Scale (GAD-7). Correlations between symptoms of pain-related TMDs and PHQ-4 and GAD-7 scores were analyzed using Spearman's correlation test. Frequencies and percentages were calculated for sex, age, TMD, PHQ-4, GAD-7, and TMD pain-screener responses. A chi-square test was performed to determine the association between demographic data and psychological profiles. Results The majority of the respondents (59.4%) reported at least one symptom of pain-related TMDs. The TMD pain score was positively correlated with PHQ-4 and GAD-7 scores. Conclusions Residents of the Al-Qassim region who experienced elevated levels of psychological distress had significantly more pain-related TMD symptoms. These findings imply a link between psychological distress and TMD symptoms.

Focus Groups to Inform the Development of a Patient-Reported Outcome Measure (PROM) for Temporomandibular Joint Disorders (TMDs)

BACKGROUND

Understanding symptoms of temporomandibular joint disorders (TMDs) can help doctors and patients document, monitor, and manage the disease and help researchers evaluate interventions. Patients with TMDs experience symptoms ranging from mild to severe, primarily in the head and neck region. This study describes findings from formative patient focus groups to capture, categorize, and prioritize symptoms of TMDs towards the development of a patient-reported outcome measure (PROM).

METHODS

We conducted ten focus groups with 40 men and women with mild, moderate, and severe TMD. Focus groups elicited descriptions of symptoms and asked participants to review a list of existing patient-reported outcomes (PROs) from the literature and patient advisor input and speak to how those PROs reflect their own experience, including rating their importance.

RESULTS

We identified 52 distinct concepts across six domains: somatic, physical, social, sexual, affective, and sleep. Focus groups identified the ability to chew and eat; clicking, popping, and other jaw noises; jaw pain and headaches; jaw misalignment or dislocation; grinding, clenching, or chewing, including at night; and ear sensations as most important. Participants with severe TMDs more often reported affective concepts like depression and shame than did participants with mild or moderate TMDs.

CONCLUSION

Findings support PROM item development for TMDs, including selecting existing PROMs or developing new ones that reflect patients' lived experiences, priorities, and preferred terminology. Such measures are needed to increase understanding of TMDs, promote accurate diagnosis and effective treatment, and help advance research on TMDs.

The Association Between Post-Traumatic Stress Disorder and Temporomandibular Disorders: A Systematic Review

The purpose of this systematic study was to discover a connection between temporomandibular joint disorders and post-traumatic stress disorder. A systematic review of observational studies on post-traumatic stress disorder and the incidence of temporomandibular joint disorders (TMD) was conducted. Electronic searches of PubMed, the Saudi Digital Library, Science Direct, the Virtual Health Library (VHL), Scopus, Web of Science, Sage, EBSCO Information Services, and Ovid were performed. There was a consensus among the reviewing examiners. Only studies with the following Medical Subject Headings (MeSH) terms were included: "Posttraumatic stress disorder" combined with "temporomandibular joint disorder," "myofascial pain," "orofacial pain," "internal derangement," "disc displacement with reduction," or "disc displacement without reduction." Only full-text studies in the English language published between 2010 and June 2020 were considered. Of a total of 381 articles meeting the initial screening criteria, only eight were included in the qualitative analysis. Overall, pain is exacerbated in patients with PTSD; that is, their TMD is heightened in all aspects of pain, chronicity, decreased response to conventional therapies, and the need for more potent treatment options as compared with patients with just TMD. The evidence, albeit weak, obtained from the studies included in this review suggests a relationship between PTSD and TMDs.

Effect of Rehabilitation of Completely Edentulous Patients With Complete Dentures on Temporomandibular Disorders: A Systematic Review

The present study evaluates the effect of rehabilitating completely edentulous patients with complete denture prosthesis on temporomandibular disorders (TMD). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to perform this systematic review, primarily to describe the technique. Manuscripts published between 1965 and December 31, 2021, were searched in the two most common electronic databases, PubMed and Cochrane Library. To find relevant scientific papers on the influence of complete dentures on temporomandibular disorders, an electronic pursuit of peer-reviewed articles confined to the English language and a dental survey were undertaken. Two observers reviewed the abstracts separately and chose five full-text papers that met the inclusion requirements. Due to the heterogeneity of the data provided, a meta-analysis could not be performed. The result of complete dentures on temporomandibular problems was studied in detail in five peer-reviewed papers. The result of the present study concluded that the complete denture could act as a conducive treatment option to the revocation of TMD for elderly edentulous patients.

Adverse Impacts of Temporomandibular Disorders Symptoms and Tooth Loss on Psychological States and Oral Health-Related Quality of Life During the COVID-19 Pandemic Lockdown

Background

Emotion and quality of life may have been impacted by the coronavirus disease 2019 (COVID-19) crisis, especially in the lockdown. The impact of temporomandibular disorders (TMD) symptoms and tooth loss on mental status and Oral Health-Related Quality of Life (OHRQoL) are not fully understood in a stressful situation.

Objectives

We aimed to investigate whether TMD and tooth loss were the impaired risks of psychological states and OHRQoL in COVID-19 lockdown, and attempt to explore other potential risk factors.

Methods

This cross-sectional study surveyed residents via an online self-reported questionnaire, when Yangzhou was in lockdown. Demographic data, clinical information, the level of anxiety, depression and OHRQoL were collected and analyzed.

Results

Painful TMD symptoms and tooth loss are the risks of more severe anxiety and depression. TMD symptoms and tooth loss worsened OHRQoL. Lower education degree (OR: 6.31, P = 0.019), TMD-related pain symptoms (OR: 10.62, P = 0.005), tooth loss (OR: 3.12, P = 0.035), sleep disorders (OR: 2.92, P = 0.049) and relatively close contacts (OR: 3.95, P = 0.020) were verified as risk factors for increased level of anxiety. With respect to depression, low socio-economic status (OR: 6.22, P = 0.021), TMD-related pain (OR: 7.35, P = 0.012), tooth loss (OR: 4.48, P = 0.009), sleep disorders (OR: 5.13, P = 0.007) and relatively close contacts (OR: 12.94, P = 0.001) were identified as independent factors for developing depression. Additionally, drinking (B: −2.584, P = 0.013) and never going to the dental clinic (B: −3.675, P = 0.024) were relevant to better OHRQoL, while TMD without pain (B: 2.797, P = 0.008), TMD-related pain (B: 12.079, P < 0.001), tooth loss (B: 2.546, P = 0.006), sleep disorders (B: 2.598, P = 0.003) were independent factors for impaired OHRQoL.

Conclusion

Painful TMD symptoms, tooth loss and sleep disorders were the impaired risks of psychological states. TMD symptoms and tooth loss damaged OHRQoL when the city was in lockdown. Therefore, individualized psychological counseling is supposed to maintain control of mental health and OHRQoL under the stressful event.

Prevalence and risk factors of erosive tooth wear among young adults in the Singapore military

OBJECTIVES

Erosive tooth wear (ETW) is defined as the irreversible chemo-mechanical loss of dental hard tissues without plaque or bacteria and has been a growing phenomenon in the general population worldwide. The aim of this study was to determine the prevalence of ETW and the associated risk factors among young military personnel in Singapore.

MATERIALS AND METHODS

This cross-sectional study consisted of a questionnaire and clinical examination of military personnel between 18 and 25 years. The questionnaire collected information on demographics, medical and dental history, lifestyle and dietary habits. Tooth wear was clinically evaluated using the Basic Erosive Wear Examination (BEWE) index. The participants were profiled into four risk categories (none, low, moderate, severe) based on the sum score. Multivariable logistic regression analysis was performed to determine the risk factors associated with the presence of ETW.

RESULTS

Out of 1296 participants evaluated, 21.8% of them had ETW. The anterior sextants were more affected by erosion than posterior sextants for both arches. The risk factors significantly associated with ETW were GERD (OR = 2.83, p = 0.041), presence of self-reported TMD symptoms (OR = 2.51, p < 0.001), acidic food (OR = 2.03, p < 0.001) and drinks (OR = 3.07, p < 0.001), high caries risk (OR = 4.59, p < 0.001) and toothbrush stiffness (OR = 4.67, p < 0.001).

CONCLUSION

ETW is prevalent among the young military population, with over half of the population at a risk of ETW. Gastric reflux disease, TMD, acidic diet, dental caries susceptibility and the use of stiff toothbrushes were identified as significant risk factors.

CLINICAL RELEVANCE

A large proportion of young military personnel exhibited mild to moderate risk of ETW. Dental professionals can identify risk-susceptible individuals at a young age and educated them with preventive measures and dietary interventions to prevent the progression of the condition.

Association between temporomandibular disorders and anxiety: A systematic review

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

Oral health-related quality of life of patients with acute and chronic temporomandibular disorder diagnostic subtypes

BACKGROUND

Studies have indicated the negative effects of temporomandibular disorders (TMDs) on oral health-related quality of life (OHRQoL). The authors investigated the OHRQoL of patients with acute and chronic TMD subtypes.

METHODS

The authors recruited a total of 830 patients. They derived TMD diagnoses using the Diagnostic Criteria for TMDs protocol involving symptom history, physical examination, and diagnostic imaging as indicated. The authors categorized patients into acute (≤ 3 months) or chronic (> 3 months) pain-related TMD (PT), nonpainful intra-articular TMD (IT), and combined TMD (CT) groups. They also gathered sociodemographic information and assessed OHRQoL with the Oral Health Impact Profile (OHIP)-TMDs. The authors evaluated data using 2-way analysis of variance and Bonferroni test and multiple regression analysis.

RESULTS

Patients in the chronic PT and CT subgroups had significantly higher mean global OHIP scores than their acute counterparts. The authors observed significant acute-chronic differences in OHIP-TMDs domain scores in 5 and 2 domains for the PT and CT groups, respectively. Patients in the acute IT group had significantly higher functional limitation scores than those in the chronic IT group. The ranking of mean global scores, in descending order was CT, PT, and IT for acute TMDs and PT, CT, and IT for chronic TMDs, with significant differences observed among the 3 TMD subtypes (P < .001).

CONCLUSIONS

Both TMD chronicity and subtypes influenced OHRQoL. Painful TMDs (PT and CT) were associated with significantly poorer OHRQoL than nonpainful TMDs. TMD chronicity appeared to affect OHRQoL only for the painful TMD conditions. Future work on the impact of TMDs on OHRQoL should strive to stratify patients by TMD chronicity and subtypes.

PRACTICAL IMPLICATIONS

TMD chronicity and subtypes influence the impact of TMDs on OHRQoL. Given that chronic painful TMDs impair quality of life, early biopsychosocial intervention of acute TMD pain is important for minimizing chronification and OHRQoL deterioration.

Comparison of psychological states and oral health-related quality of life of patients with differing severity of temporomandibular disorders

BACKGROUND

Studies on temporomandibular disorder (TMD) severity in patient populations are scarce.

OBJECTIVES

This study sought to compare the psychological states and oral health-related quality of life (OHRQoL) among patients with differing TMD severity.

METHODS

Adult patients (≥18 years old) with and without (controls) TMDs were recruited from the TMD/oro-facial pain centre and prosthodontics department, respectively. The presence and severity of TMDs were established with the Fonseca Anamnestic Index (FAI), and TMD diagnoses were confirmed with the Diagnostic Criteria for TMDs (DC/TMD). Psychological states and OHRQoL were examined with the Depression, Anxiety, Stress Scales-21 (DASS-21) and Oral Health Impact Profile for TMDs (OHIP-TMD). Data were subjected to chi-square, Kruskal-Wallis/Mann-Whitney U tests and Spearman's correlation (α = .05).

RESULTS

A total of 961 participants with a mean age of 32.99 ± 13.14 years (71.19% women) were assessed. Frequencies of the various TMD categories were as follows: no TMD/controls (12.07%), mild TMD (24.56%), moderate TMD (40.37%) and severe TMD (23.00%). The three most common TMD-related symptoms were TMJ noises, mouth opening difficulty and muscle pain. Participants with moderate/severe TMD presented a higher proportion of intra-articular and/or combined disorders. They reported significantly higher levels of depression, anxiety, stress and poorer OHRQoL than their counterparts with no/mild TMD (p < .001). Moderate-to-strong correlations were observed between FAI and DASS-21/OHIP-TMD scores (rs = 0.42-0.72).

CONCLUSIONS

Patients with moderate/severe TMD had significantly higher levels of psychological disturbance and poorer OHRQoL. As OHRQoL and psychological states are correlated, psychological well-being must be considered when managing patients with moderate/severe TMDs.

Association between Stress at Work and Temporomandibular Disorders: A Systematic Review

Temporomandibular disorders (TMD) have been traditionally associated with psychosocial factors; however, occupational stress as a factor related to TMD has not been adequately assessed in the literature. The aim was to investigate the association between stress at work and TMD on adult paid workers. An electronic search included PubMed, Scopus, Web of Science, Embase, and LILACS databases. Manual searches in the included articles' reference and gray literature were performed. There were no restrictions regarding language or publication period. The inclusion criteria comprised observational studies with paid workers of any category, of both sexes, above 18 years old, assessing occupational stress/stress or distress and TMD as diagnosis or isolated signs and symptoms. Methodological quality was evaluated using Joanna Briggs tools. We narratively assessed the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. We collected 12 studies. 50% reported a positive association between stress and TMD diagnostic across various job categories. On the other hand, TMJ sounds (a TMD sign) and work stress were associated only in a musicians' population. However, the shortage of eligible articles and the methodological limitations provided a very low certainty of the evidence; only 4 of the studies used validated tools for both stress and TMD (2 reporting positive association). The association between stress and TMD is inconclusive by the available data. In the future, we expect more robust epidemiologic studies addressing these relevant aspects.

Prevalence of self-reported pain-related temporomandibular disorders and association with psychological distress in a dental clinic setting

Objectives

To investigate the prevalence of self-reported pain-related temporomandibular disorders (TMDs) and its association with psychological status in a dental clinic setting.

Methods

In this cross-sectional study, patients were asked to complete a TMD pain screener and the Patient Health Questionnaire-4 (PHQ-4). Correlations between symptoms of pain-related TMDs and PHQ-4 scores were analysed using Spearman’s correlation test. Symptoms of pain-related TMDs were compared between four groups of participants with different psychological profiles using the Kruskal–Wallis test followed by multiple comparisons. The level of significance was adjusted using the Dunn–Bonferroni test.

Results

The prevalence of self-reported pain-related TMDs was 22.2%. TMD pain score was positively correlated with PHQ-4 score. The high anxiety and the comorbidity groups had significantly higher TMD pain scores than the controls.

Conclusion

There was a high prevalence of self-reported pain-related TMDs, which was correlated with scores on all psychological assessment scales. Symptoms of pain-related TMDs were significantly greater in patients with high anxiety scores, regardless of depression level.

Number and type of temporomandibular disorder symptoms: their associations with psychological distress and oral health-related quality of life

OBJECTIVE

In this case-control study, we investigated the presence of differing numbers and types of temporomandibular disorder (TMD) symptoms, their association with psychological distress, and their impact on oral health-related quality of life (OHRQoL).

STUDY DESIGN

We recruited a total of 814 participants with TMD and 147 control subjects. The participants were instructed to complete the Diagnostic Criteria for Temporomandibular Disorders Symptom Questionnaire; the Depression, Anxiety and Stress Scale-21; and the Oral Health Impact Profile-Temporomandibular Disorders. The participants were subsequently categorized by their number and type of TMD symptoms. Data were analyzed with the Kruskal-Wallis/Mann-Whitney U test (α = .05).

RESULTS

The mean age of the participants (N = 961) was 32.99 ± 13.14 years, and 79.2% were women. Participants with more and all types of TMD symptoms generally exhibited significantly higher levels of psychological distress and worse OHRQoL (P < .001). Those with TMD pain plus temporomandibular joint (TMJ) sounds/dysfunction had significantly greater psychological distress, whereas those with painful symptoms and TMJ dysfunction experienced significantly more impairment in OHRQoL than individuals with only TMJ sounds.

CONCLUSIONS

Psychological states and OHRQoL are influenced by the number and type of TMD symptoms. Individuals with more and all types of pain-related TMD symptoms with/without intra-articular features had greater psychological distress and OHRQoL impairment.

Temporomandibular disorder subtypes, emotional distress, impaired sleep, and oral health-related quality of life in Asian patients

OBJECTIVES

This study determined the differences in emotional states, sleep and oral health-related quality of life (OHRQoL) between patients with pain-related and intra-articular Temporomandibular disorders (TMDs), and associated emotional symptoms with sleep and OHRQoL.

METHODS

Participants were recruited from a tertiary TMDs referral centre. The Depression, Anxiety, Stress Scales-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI) and Oral Health Impact Profile-TMDs (OHIP-TMDs) were used to assess emotional states, sleep and Oral health-related quality of life (OHRQoL), respectively. TMD-related and sociodemographic data were also gathered. Patients were divided into pain-related (PT), intra-articular (IT) and combined TMDs (CT) groups based on the Diagnostic Criteria for TMDs. Data were analysed using one-way ANOVA, Chi-square test, Pearson's correlation and logistic regression analysis with the significance level set at P < .05.

RESULTS

Data from 1079 participants with a mean age of 29.6 ± 14.2 years were appraised (93.3% response rate). The severity/prevalence of emotional distress, impaired sleep and OHRQoL of the PT/CT groups were higher than the IT group. Moderate-to-strong inter-relationships between emotional, sleep and OHRQoL variables were more explicit for participants with painful TMDs. Logistic regression analysis demonstrated that painful TMDs were associated with higher stress and poorer OHRQoL with odds ratios (ORs) of 1.482 (95% CI 1.039-2.114) and 6.502 (95% CI 3.201-13.210), respectively.

CONCLUSIONS

Painful TMDs are associated with higher levels of emotional distress, sleep and OHRQoL impairments. Routine evaluation of the biopsychosocial distress, especially stress and life quality, is necessary for patients with painful TMDs.

Age-related differences in diagnostic categories, psychological states and oral health-related quality of life of adult temporomandibular disorder patients

OBJECTIVES

The peak prevalence of temporomandibular disorders (TMDs) may occur in middle age. This study determined the proportion of matured adults seeking TMD treatment and compared their diagnostic, psychological and oral health-related quality-of-life (OHRQoL) profiles to younger patients.

METHODS

Adult subjects were recruited from a tertiary TMD centre and assigned to three age groups, namely 18-44 years (young adults [YA]), 45-64 (middle-aged adults [MA]) and ≥65 (old adults [OA]). TMD diagnoses were established with the Diagnostic Criteria for TMDs and categorised as pain-related (PT), intra-articular (IT) and combined (CT) TMDs. Psychological states and OHRQoL were assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Oral Health Impact Profile-TMDs (OHIP-TMDs). Demographic, DASS-21, and OHIP-TMDs data were analysed using chi-square test, one-way ANOVA and Pearson's correlation (P < .05).

RESULTS

Middle-aged (19.7%; 136/692) and old (4.0%; 28/692) adults comprised about a quarter of the TMD patients. Although gender distribution was comparable, significant differences in TMD categories were observed (P < .001). Pain-related TMDs were more prevalent in the MA/OA groups while intra-articular TMDs were more frequent in the YA group. No significant difference in DASS-21 and total OHIP scores was noted among three groups. However, the MA and OA groups had significantly lower OHRQoL in the physical pain domain. Correlations between DASS-21 and OHIP-TMDs scores varied with age and ranged from r_s  = 0.47-0.92.

CONCLUSIONS

Matured patients constituted a quarter of TMD cohort and presented higher frequencies of painful TMDs. They have similar psychological profiles to younger patients but experienced lower OHRQoL in physical pain domain.

Perceived xerostomia, stress and periodontal status impact on elderly oral health-related quality of life: findings from a cross-sectional survey

BACKGROUND

To investigate if self-perceived xerostomia and stress are significant variables on the Oral-Health Related Quality of Life (OHRQoL) of elderly patients, considering the periodontal status, oral hygiene habits and sociodemographic characteristics simultaneously.

METHODS

The study cohort included 592 participants (320 females/272 Males), aged 65 years or older, representing the elder inhabitants of the Study of Periodontal Health in Almada-Seixal (SoPHiAS). Patients answered a socio-demographic and oral hygiene habits questionnaire. The Oral Health Impact Profile-14 (OHIP-14), Summated Xerostomia Inventory-5 (SXI-5) and Perceived Stress Scale-10 (PSS-10) were used. Full-mouth circumferential periodontal inspection was carried out. Multivariable regression analyses were used considering the level of periodontitis, clinical characteristics, the number of teeth, SXI, PSS-10, age, gender and oral hygiene habits.

RESULTS

Self-perceived xerostomia and stress showed a positive significant correlation with OHRQoL and each of its domains. Multiple linear regression analysis demonstrated the significant impact of SXI-5 (B = 1.20, p <  0.001) and PSS-10 (B = 0.35, p <  0.001) on the OHRQoL. SXI-5 (Odds Ratio (OR) = 1.28, p <  0.001) and PSS-10 (OR = 1.03, p = 0.022) were associated with a more frequently affected OHRQoL. The number of missing teeth, being male, mean probing depth and mean clinical attachment loss were also significant towards a frequently affected OHRQoL. Conversely, age was negatively associated with a lower OHRQoL.

CONCLUSION

Self-perceived xerostomia and stress are significant variables towards OHRQoL in elderly patients. Future studies should consider these self-perceived xerostomia and stress when investigating the impact of periodontitis and missing teeth on quality of life of older adults.

Functional, physical and psychosocial impact of Temporomandibular Disorders in adolescents and young adults

Background

This community-based study investigated the functional, physical and psychosocial impact of Temporomandibular Disorders (TMDs) in adolescents and young adults. It also determined the discriminative capacity of a TMDs-specific oral health related quality of life (OHRQoL) instrument and compared three formats of appraising OHRQoL data.

Material and Methods

Subjects were recruited from a local Polytechnic. The presence of TMDs was established with the Fonseca Anamnestic Index (FAI), whilst TMDs-specific OHRQoL was evaluated with the Oral Health Impact Profile–TMDs (OHIP-TMDs). Demographic information, FAI and OHIP-TMDs responses were gathered with an on-line questionnaire. Data was analysed using Mann-Whitney U-test, chi-square test and Spearman’s rho correlation with significance level set at 0.05.

Results

Data from a total of 244 participants were compiled and examined. The “no TMDs” (NT) group consisted of 140 subjects (119 females; 21 males) with a mean age of 20.41±3.29 years, while the “with TMDs” (WT) group composed of 104 subjects (88 females; 16 males) aged 19.82±3.04 years. Significant differences in median severity scores were observed between subjects with and without TMDs for all OHIP-TMDs domains and total OHIP (p values < 0.001). For appraisal of extent and prevalence, significant differences were again observed (p values < 0.05) with the exception of the functional limitation and handicap domains.

Conclusions

TMDs impacted physical and psychosocial well-being of adolescents and young adults. OHIP-TMDs, preferably appraised by severity, extent and prevalence, was able to discriminate between subjects with and without TMDs. It holds promise as a TMDs-specific OHRQoL instrument for epidemiological studies.

Key words:Temporomandibular Disorders, Oral health, Quality of life, Biopsychosocial.