A Self-Reported Association between Temporomandibular Joint Disorders, Headaches, and Stress

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.

Evaluation of the Relationship Between Head Posture, Mandibular Movements and Emotional Tension

Introduction: The head, due to its structure and assigned functions, is a unique part of our body. In a number of studies, an association has been confirmed between the base of the head, the cervical spine, and temporomandibular joint disorders. Research objective: The aim of the study was to evaluate the correlation of spatial head position, temporomandibular joint mobility and emotional tension. Material and methods: The study comprised32 participants, aged 20 to 30 years. The position of the head in the sagittal and frontal planes was evaluated via the photogrammetric method. The mobility of the temporomandibular joints was assessed by measurements made with a ruler. Electrodermal activity was measured with the "Bitalino 3DP by BEEVERYCREATIVE" device, and stress intensity assessment was estimated using the PSS-10 scale. Results: A significant (p<0.01) linear correlation was found between electrodermal activity (EDA Min) and the values of angles describing head tilt (FHT1 and HTA). Higher EDA values are associated with higher angle values. No significant correlations (p>0.05) were found between mandibular mobility and EDA scores, or between mandibular mobility measurements and head position. Conclusions: The study revealed a relationship between head positioning and electrodermal EDA activity.

Temporomandibular joints disorders (TMDs) prevalence and their relation to anxiety in dental students

Background: Temporomandibular joint disorders (TMDs) are very common disorders affecting the population and causing pain. Researchers have reported a high prevalence of TMDs among university students due to increased distress. The aims of this study were to determine the frequency of TMDs in Umm al-Qura University (UQU) dental students using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and to examine the relationship between anxiety, bruxism, and TMDs among those students. Methods: The DC/TMD pain screener questionnaire was completed by dental students. Students who reported TMD pain or had at least one positive TMD symptom were invited to the dental clinic for a full TMJ evaluation. History of bruxism was documented and an ultra-brief tool for detecting anxiety and depression (Patient Health Questionnaire-4 PHQ) was completed by all students. Results: A total of 240 students responded to the TMD pain screener in which 119 reported at least one TMJ symptom. Only 93 dental students presented to clinical examination in which 64.5% (n=60) of them had temporomandibular joint disorders. Disc displacement with reduction and local myalgia (38.7% & 32.25%, respectively) were the most frequent diagnosis. A total of 29% (n=27) of students had more than one diagnosis. Overall, 41 participants (44.09%) reported a positive response to the anxiety scale and (n=38) 40% of participants reported parafunctional habits. Both the history of bruxism and anxiety were significantly related to TMDs (P=0.0002) and also significantly higher in women of higher academic years (P≤0.01). Conclusions: This study found a high prevalence of TMDs among UQU dental students. Disc displacement with reduction was the most prevalent disorder. Bruxism and anxiety were associated with painful TMDs.

Prevalência de cinesiofobia e catastrofização em pacientes com disfunção temporomandibular

RESUMO Objetivo: identificar a frequência e os níveis de cinesiofobia e catastrofização em pacientes com Disfunção Temporomandibular que realizaram terapia fonoaudiológica. Métodos: a amostra compreendeu pacientes com Disfunção Temporomandibular muscular e mista com predominância muscular, grupo de estudo e adultos saudáveis, o grupo controle. Os instrumentos utilizados foram: Diagnostic Criteria for Temporomandibular Disorders, Escala Tampa para Cinesiofobia e Escala de Catastrofização da Dor. A análise estatística foi composta do Teste de Mann-Whitney para comparar as médias entre os grupos de cada escala e o teste de Coeficiente de Correlação de Spearman para analisar a correlação entre as escalas em cada grupo e sua significância. Resultados: foi identificado um alto índice de catastrofização da dor no grupo de estudo em comparação ao grupo controle. Quanto à cinesiofobia, houve maior índice positivo para essa variável no grupo de estudo e menor para o grupo controle. Além disso, identificou-se correlação moderada e positiva entre a cinesiofobia e catastrofização no grupo de estudo. Conclusão: Pacientes com Disfunção Temporomandibular possuem níveis de cinesiofobia e catastrofização mais altos que pacientes que não foram diagnosticados com o distúrbio.

Prevalence of kinesiophobia and catastrophizing in patients with temporomandibular disorders

ABSTRACT Purpose: to identify the frequency and levels of kinesiophobia and catastrophizing in patients with temporomandibular disorders who had been submitted to speech-language-hearing therapy. Methods: the sample comprised patients with myogenous (predominantly) and mixed temporomandibular disorders in the study group and healthy individuals in the control group. The instruments used were the Diagnostic Criteria for Temporomandibular Disorders, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale. Statistical analyses were performed with the Mann-Whitney test (to compare the means on each scale between the groups) and the Spearman’s correlation coefficient test (to analyze the correlation between the scales in each group and its significance). Results: the study group had a higher pain catastrophizing index than the control group. Likewise, the study group had greater kinesiophobia positive indices, whereas the control group had lower ones. A moderate positive correlation was also identified between kinesiophobia and catastrophizing in the study group. Conclusion: patients presented with temporomandibular disorders have higher levels of kinesiophobia and catastrophizing than subjects not diagnosed with the disorder.

Association between primary headaches and temporomandibular disorders: A systematic review and meta-analysis

BACKGROUND

The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?

TYPES OF STUDIES REVIEWED

The protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 7 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Eight of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 6 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 3.16; 95% CI, 1.80 to 5.54 to OR, 13.06; 95% CI, 2.79 to 61.12), migraines (OR, 5.35; 95% CI, 3.04 to 9.40 to OR, 6.22; 95% CI, 3.81 to 10.14), and chronic headaches (OR, 40.40; 95% CI, 8.67 to 188.15 to OR, 95.93; 95% CI, 12.53 to 734.27) were calculated. Articular TMDs without pain were evaluated in only 1 article, in which ORs of 1.78 (95% CI, 0.90 to 3.51) for migraines and 1.04 (95% CI, 0.53 to 2.06) for tension-type headache were reported. Three studies were classified as moderate risk of bias and 5 as low risk of bias. The certainty of evidence varied between very low and low.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Recognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.

Association of sleep quality and psychological aspects with reports of bruxism and TMD in Brazilian dentists during the COVID-19 pandemic

BACKGROUND

Dentists are exposed to contamination by SARS-CoV-2 due to dental interventions, leading to a state of alert and potential risk of negative impact in mental health and sleep quality, associated with Temporomandibular Disorder (TMD) and bruxism.

OBJECTIVE

to evaluate the psychosocial status, sleep quality, symptoms of TMD, and bruxism in Brazilian dentists (DSs) during the COVID-19 pandemic.

METHODOLOGY

The sample (n=641 DSs) was divided into three groups (quarantined DSs; DSs in outpatient care; and frontline professionals), which answered an electronic form containing the TMD Pain Screening Questionnaire (Diagnostic Criteria for Temporomandibular Disorders - DC/TMD), the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety and Stress Scale (DASS-21), and the sleep and awake bruxism questionnaire. ANOVA test and Mann Whitney post-test were used, with Bonferroni adjustment (p<0.016) and a 95% confidence level.

RESULTS

Probable TMD was found in 24.3% (n=156) of the participants, while possible sleep and awake bruxism were diagnosed in 58% (n=372) and 53.8% (n=345) of them, respectively. Among all variables evaluated, only symptoms of depression were significantly greater in the quarantined DSs group when compared to those who were working at the clinical care (p=0.002). Working DSs were significantly less likely (OR=0.630, p=0.001) to have depressive symptoms. Those who were not worried or less worried about the pandemic were less likely to experience stress (OR=0.360), anxiety (OR=0.255), and poor sleep quality (OR=0.256). Sleep had a strong positive and moderate correlation with psychological factors on frontline workers and DSs in outpatient care, respectively.

CONCLUSION

The results suggest confinement may have a more negative impact on the life of DSs than the act of being actively working. The concern about Covid-19 and poor sleep quality was significantly prevalent and may negatively affect the quality of life of DSs. Thus, further research on the topic is needed.

Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic

Aim

This study gives insights into the association between the use of personal protective equipment (PPE), wearing time of masks and stress among frontline nursing staff during the COVID‐19 pandemic.

Background

PPE can have physical consequences like headache and pain, which could result in increased nurse stress levels.

Methods

A total of 2600 nurses participated in this online survey. The questionnaire is based on literature and includes the perceived level of stress scale.

Results

We found no significant association between the use of PPE and stress. Nurses who wore masks for more than 8 h had significant higher stress levels than those who used the masks for a shorter period.

Conclusions

The duration of wearing masks is associated with nurse's stress level. Our findings can help nurses to argue a higher frequency of breaks and a maximum duration of mask usage in their organisations.

Implications for Nursing Management

We recommend that nursing managers implement practical strategies such as a mask break task force. This task force could promote awareness for mask breaks and recommend and allocate rooms or locations such as balconies for mask breaks.

Otological manifestation of temporomandibular joint disorder in Ekiti, a sub-Saharan African country

OBJECTIVE

To determine the prevalence, sociodemographic features, and clinical presentation of temporomandibular joint disorder in otorhinolaryngological practice.

METHODS

This prospective hospital-based study involved patients diagnosed with temporomandibular joint disorder in our institution's ear, nose, and throat department. Data for this study were obtained from the patients using pretested interviewer-assisted questionnaires.

RESULTS

The prevalence of temporomandibular joint disorder in this study was 1.3%. The study population included 17 (26.2%) male patients with a male:female ratio of 1.0:2.8. Joint disorder accounted for 75.4% of all disorders, while both mastication muscle and joint disorder accounted for 21.5%. A majority of the patients (47.7%) presented between weeks 1 and 13 of the illness. Unilateral temporomandibular joint disorder accounted for 98.5% of all disorders. The main otologic clinical features were earache and a dull tympanic membrane in 100% and 35.4% of patients, respectively. Middle ear assessment revealed type A in 73.8% of patients and type B in 20.0% according to Jerger's classification system of tympanometry. Most patients (81.5%) were referred by their family physician. All patients had undergone prehospital treatment prior to presentation.

CONCLUSION

Temporomandibular joint disorder is a common presentation in medical practice. Common clinical features include ear, joint, and mastication muscle disorders.

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.

Evaluation of temporomandibular disorders among dental students of Saudi Arabia using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): a cross-sectional study

BACKGROUND

Temporomandibular disorders (TMD) are a broad category of conditions arising from the various components of the temporomandibular joint complex. Bio-psychosocial model is the most accepted theory describing the etiopathogenesis of TMD. Dental students are vulnerable to psychological disorders, including anxiety, depression, and stress. Hence, the aim of the current study was to evaluate the prevalence and possible risk factors of TMD among dental students of various academic levels and explore the association of TMDs with demographic, academic, and psychosocial parameters.

METHODS

A total of 246 students of a Saudi Arabia dental school were chosen for the study. After getting consent, all students were examined according to the Diagnostic Criteria for Temporomandibular Disorders, including Axis I and II components.

RESULTS

The overall cross-sectional prevalence of TMD was found to be 36.99%. Pain arising from the jaw, temple, and the peri-auricular area were the most commonly reported symptoms and elicited signs during examination. Among the pain-related TMD, myalgia was the commonest diagnosed condition, whereas disc displacement with reduction was found prevalent in the intra-articular disorder category. Female (OR = 1.94; P = 0.004), married (OR = 1.74; P = 0.04), and students in clinical academic levels (OR = 1.65; P = 0.03) were found to have significantly increased risk of TMD. Among the psychosocial parameters, anxiety (OR = 1.55; P = 0.04) and parafunctional behaviours (OR = 2.10; P < 0.001) were shown to increase the risk of developing TMD. Students with any TMD reported to have significantly higher pain intensity levels (OR = 1.68; P = 0.01) and jaw functional limitations (OR = 1.45; P = 0.008).

CONCLUSION

Dental students, especially in clinical levels were shown to pose a higher risk of developing TMD, hence strategies such as academic counselling and objective evaluation via rubrics should be planned to modify the administration of the curriculum, training methods and evaluation process.