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

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.

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.

The Association Between Orofacial Pain and Depression: A Systematic Review

Background

The occurrence of orofacial pain is often accompanied by comorbid conditions such as depression. Even though previous studies suggested a bidirectional correlation between orofacial pain and psychological factors, some studies still provided contradictory results.

Objective

This systematic review aimed at providing scientific evidence regarding the association between orofacial pain and depression in published literature.

Methods

The current study is a systematic literature review (PROSPERO registration no. CRD42023438596) that was conducted by reviewing cross-sectional studies that investigated the association between orofacial pain and depression. Article selection was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Articles searching was performed by using three databases, namely PubMed, ScienceDirect, and Scopus using the Boolean operator method. Article screening was carried out by applying the inclusion and exclusion criteria, as well as duplication checking, suitability checking, and compatibility checking. Reviewed articles went through the risk of bias evaluation form from the Joanna Briggs Institute (JBI). Extracted data were analyzed in a qualitative method.

Results

Twelve studies that were conducted on 5557 participants were included in the final review. After all articles were analyzed, the correlation between orofacial pain and depression was revealed. Most articles revealed a positive correlation between orofacial pain and depression, and the rest showed how orofacial pain patients showed significantly higher depression scores compared to those individuals without orofacial pain.

Conclusion

The results of this systematic review suggested a correlation between orofacial pain and depression with varying degrees. Incorporating potential depressive symptoms' treatment, when treating orofacial pain patients, should be part of the treatment plan.

Association Between Orofacial Pain and Anxiety: A Systematic Review

The prevalence of orofacial pain continues to increase. Additionally, the rising number has been accompanied by reduced quality of life of its sufferers. An assumed association between orofacial pain and anxiety has surfaced due to the results of several studies that show higher occurrence of anxiety in people experiencing orofacial pain, compared to those who are orofacial-pain-free. The aim of this systematic review was to discover past research on orofacial pain and its relationship to anxiety, and to understand the relationship between acute and chronic orofacial pain and anxiety. The current systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) rules. Study searches were carried out using three databases, namely PubMed, ScienceDirect, and Scopus. Article selection was carried out in several stages and was based on inclusion and exclusion criteria and continued by assessing the methodological quality and risk of bias of each article. The risk of bias was analyzed by using the critical review tool for cross-sectional studies from the Joanna Briggs Institute (JBI). The selection process led to a review process of 13 cross-sectional research articles. The systematic review showed a positive relationship between orofacial pain and anxiety, with variations in the strength of the relationship (weak to moderate). Most articles revealed that anxiety is a risk factor for orofacial pain. A correlation between chronic orofacial pain and anxiety was mentioned in several studies. It can be concluded that there is an existing relationship between orofacial pain and anxiety, especially chronic orofacial pain. Prospero registration number: CRD42023385409.

Changes in COVID-19 Perception and in TMD Prevalence after 1 Year of Pandemic in Italy

OBJECTIVES

 The study aims to report the perception of dental practices and assess the individual's psychological stress level and related temporomandibular disorders (TMD) symptoms by evaluating the changes that occurred during the year following the first lockdown (May 2020).

MATERIALS AND METHODS

 An online questionnaire was submitted to the Italian population between 20 March and 20 April 2021. It was sent via online platforms and included 14 questions.

STATISTICAL ANALYSIS

 The data were analyzed using a chi-squared test and a comparison of the current data with the May 2020 survey data was performed using independent samples t-tests. The level of significance was set at p < 0.05.

RESULTS

 Forty-three percent of subjects (872) considered the dental practice to be a place with a high risk of infection. Temporomandibular pain and joint sounds were reported by 35.7% (724) of the population; of these more frequently were women (71.8%, 520/724, p < 0.001). About 31% of the participants had moderate/severe psychological distress and, among them, it was found that 46.4% (294/634) reported TMD pain (p < 0.001) and 34.9% (221/634) complained of temporomandibular joint sounds (p < 0.001).

CONCLUSIONS

 Most participants did not consider dental practices as a place with a higher risk of coronavirus disease 2019 transmission and, in contrast to the data from a previous study, people were less afraid to go to dental practices. After the first year of the pandemic, the level of stress and depression increased and the prevalence of TMD pain and joint sounds increased, in association with gender, age, and level of distress.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Associations among Orthodontic History, Psychological Status, and Temporomandibular-Related Quality of Life: A Cross-Sectional Study

OBJECTIVES

This cross-sectional study aimed to evaluate the associations among orthodontic history, psychological status, and temporomandibular-related quality of life.

METHODS

A questionnaire was developed and distributed to students in a local college, containing questions about demographic information, the Patient Health Questionnaire-4 (PHQ-4), the Fonseca anamnestic index, and the Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD). The respondents were divided into with orthodontic history (OS) group and without OS group. Binary logistic regression and multiple linear regression were performed for statistical analysis.

RESULTS

A total of 531 valid questionnaires were collected, covering 161 participants with OS and 370 participants without OS. No statistically significant differences were observed in the scores of PHQ-4 between the two groups. There was statistical difference in the prevalence of TMD (with OS group, 54.66%; without OS group, 40.81%) and the mean value ( ± standard deviations) of the scores of OHIP-TMD (with OS group, 9.64 ± 12.36; without OS group, 6.64 ± 10.79) (p < 0.05). After adjusting confounding factors, participants with OS have worse temporomandibular-related quality of life and a higher risk of having TMD than the participants without OS.

CONCLUSIONS

Orthodontic history was related with the higher prevalence of TMD and worse temporomandibular-related quality of life, but not related with psychological distress, and the cause-and-effect relationship needs further exploration.

Unsupervised Machine Learning Identified Distinct Population Clusters Based on Symptoms of Oral Pain, Psychological Distress, and Sleep Problems

Objectives:

The aims of this study were to explore the use of unsupervised machine learning in clustering the population based on reports of oral pain, psychological distress, and sleep problems and to compare demographic and socio-economic characteristics as well as levels of functional domains (work, social, and leisure) between clusters.

Materials and Methods:

In this cross-sectional study, a total of 1613 participants from the National Health and Nutrition Examination Survey in 2017–2018 were analyzed. Five variables, including oral pain, depression, anxiety, sleep apnea, and excessive daytime sleepiness, were selected for cluster analysis using the k-medoids clustering algorithm. The distribution of categorical variables between clusters was assessed using χ² test. One-way analysis of variance and Kruskal–Wallis H test were used to compare numerical variables as appropriate.

Results:

Five distinct clusters were identified: healthy, norm, anxiety, apnea-comorbid, and pain-comorbid. The apnea-comorbid cluster had mean age of 59 years and higher proportion of men. The pain-comorbid cluster had mean age of 56 years and higher proportion of women. Whites constituted a majority of both comorbid clusters. The pain-comorbid cluster demonstrated the least percentage of individuals with college degree, the lowest income, and significant impairment in all functional domains.

Conclusion:

Through the use of unsupervised machine learning, the clusters with comorbidity of oral pain, psychological distress, and sleep problems have emerged. Major characteristics of the comorbid clusters included mean age below 60 years, White, and low levels of education and income. Functional domains were significantly impaired. The comorbid clusters thus call for public health intervention.

Temporomandibular disorder-related characteristics and treatment outcomes in Oromandibular Dystonia patients in two different clinical settings: A cross-sectional study

INTRODUCTION

Clinical presentation of oromandibular dystonia (OMD) is variable that can be further complicated by the presence of temporomandibular disorder (TMD) symptoms. We sought to evaluate variations in the clinical presentation of OMD patients, particularly TMD-related characteristics, in two clinical settings.

METHODS

In a cross-sectional study design, a Web-based data collection survey was provided to eligible patients with OMD from movement disorder (MD) and oro-facial pain (OFP) clinics. The survey questionnaire was designed to collect information on demographic characteristics, clinical presentation particularly related to TMD, quality of life and treatment outcomes. Validated questionnaires were used when available such as the TMD Pain Screener, EuroQol 5-Dimensions 5-Levels (EQ-5D-5L), Jaw Functional Limitation Scale and Global Rating of Change Scale.

RESULTS

Of 53 eligible patients, 31 responded to the survey for a 58% response rate. Forty-eight per cent of patients in the MD clinic and 60% of patients in the OFP clinic reported jaw pain along with involuntary movements. Of those, 90% from the MD group and 83% from the OFP group screened positive with the TMD Pain Screener at the onset of symptoms based on recall. Positive TMD Pain Screener response was observed in about 40% of patients in both clinics within 30 days of questionnaire response. No statistically significant differences were observed between two groups for any measured variables.

CONCLUSION

Patients with OMD have features of TMD, irrespective of the clinical setting in which they seek and receive care. OMD patients from both clinics were similar in terms of clinical presentation, quality of life and treatment outcomes.