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Yap AU, Lei J, Liu C, Huang Z, Fu KY. Correlates Between Temporomandibular Disorder Symptom Severity, Psychological Distress, Well-Being, and Oral Health-Related Quality of Life: Insights From Chinese Young Adults. J Oral Rehabil 2025; 52:795-806. [PMID: 39789838 DOI: 10.1111/joor.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 12/17/2024] [Accepted: 12/20/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND There is limited understanding of how temporomandibular disorder (TMD) symptoms, psychological distress, and well-being are related to each other and to OHRQoL in Chinese young adults. OBJECTIVES This study aimed to identify correlations between TMD symptom severity, psychological status, and OHRQoL while also examining factors associated with low OHRQoL. METHODS Participants, recruited from a major university in the capital city, completed a survey that included demographics, the Chinese versions of the expanded five TMD symptoms (5Ts) screener, Depression, Anxiety, Stress Scales-21 (DASS-21), Ryff's Scales of Psychological Well-being-18 (SPWB-18), and Oral Health Impact Profile for TMDs (OHIP-TMD). Data were analysed using Chi-square and Kruskal-Wallis/Mann-Whitney U tests, Spearman's correlation, and logistic regression (α = 0.05). RESULTS The study sample consisted of 414 individuals (mean age 22.0 years [SD 2.1], 77.8% female). Among them, 23.4%, 22.2%, 15.7%, and 38.6% had no (NT), intra-articular (IT), pain-related (PT), and combined (CT) TMD symptoms, respectively. Significant differences were observed in global TMD severity (CT>IT, PT>NT), global distress (CT>IT, NT), and OHRQoL (CT>IT, PT, NT), but not global well-being. Global TMD severity was significantly, albeit weakly, correlated with global distress (rs = 0.32) and global well-being (rs = -0.12). Global distress, in turn, showed a significant but weak negative association with global well-being (rs = -0.34). Both global TMD severity and global distress exhibited moderate correlations with global OHIP (rs = 0.63/0.42). CONCLUSIONS Global TMD severity, incorporating symptom duration, frequency, intensity, and interference, was the main determinant of low OHRQoL in Chinese young adults.
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Affiliation(s)
- Adrian Ujin Yap
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore
| | - Jie Lei
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Chengge Liu
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Zhiwei Huang
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
| | - Kai Yuan Fu
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Yap AU, Liu C, Fu KY, Lei J. Symptom Dimensions of Temporomandibular Disorders: Correlates With Emotional Distress, Jaw Function and Oral Health-Related Quality of Life. J Oral Rehabil 2025. [PMID: 40346738 DOI: 10.1111/joor.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 04/20/2025] [Accepted: 04/28/2025] [Indexed: 05/12/2025]
Abstract
BACKGROUND A unified framework for assessing temporomandibular disorder (TMD) pain and dysfunction across multiple symptom dimensions is beneficial. OBJECTIVES The study explored the associations between TMD symptom subtypes and dimensions with emotional distress, jaw function and oral health-related quality of life (OHRQoL). Additionally, it examined factors linked to high jaw functional limitation (JFL) and low OHRQoL. METHODS Participants, recruited from a major university, completed a survey that included demographics, the four-dimensional five TMD symptoms (5Ts-4D) screener, depression, anxiety and stress scales-21 (DASS-21), JFL scale-8 (JFLS-8) and oral health impact profile for TMDs (OHIP-TMD). Data were analysed using Chi-square and nonparametric tests, along with logistic regression (α = 0.05). RESULTS Among the 414 participants (mean age 22 years, 77.8% women), 23.4% reported no TMD symptoms (NT), while 15.7%, 22.2% and 38.6% experienced pain-related (PT), intra-articular (IT) and combined (CT) symptoms respectively. Notable differences in global TMD severity (CT>IT/PT>NT), global distress (CT>IT, NT), JFL (CT>PT, IT, NT) and global OHIP (CT>IT/PT/NT; IT>NT) scores were observed. Moderate correlations were found between global TMD severity and both JFL and global OHIP in the PT and CT groups (rs 0.41-0.64), and between global distress and these factors in the CT group (rs 0.59-0.61). High JFL was associated with symptom interference (OR 1.38) and anxiety (OR 1.20), while low OHRQoL was related to symptom duration (OR 1.26) and interference (OR 2.09). CONCLUSIONS Individuals with CT show elevated symptom severity, emotional distress, jaw function and OHRQoL impairments. Tailored interventions targeting TMD duration, interference and anxiety could improve outcomes.
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Affiliation(s)
- Adrian Ujin Yap
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Division of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore
| | - Chengge Liu
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Kai Yuan Fu
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Jie Lei
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Lin Z, Zhou C, Hu Z, Zhang Z, Cheng Y, Fang B, He H, Wang H, Li G, Guo J, Guo W, Li X, Zheng G, Li Z, Zeng D, Liu Y, Liu Y, Hu M, Xia L, Zhao J, Song Y, Li H, Ji J, Song J, Chen L, Wang T. Expert consensus on imaging diagnosis and analysis of early correction of childhood malocclusion. Int J Oral Sci 2025; 17:21. [PMID: 40164580 PMCID: PMC11958731 DOI: 10.1038/s41368-025-00351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 01/16/2025] [Accepted: 01/20/2025] [Indexed: 04/02/2025] Open
Abstract
Early correction of childhood malocclusion is timely managing morphological, structural, and functional abnormalities at different dentomaxillofacial developmental stages. The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion. This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence, aiming to provide general guidance on appropriate imaging examination selection, comprehensive and accurate imaging assessment for early orthodontic treatment patients.
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Affiliation(s)
- Zitong Lin
- Department of Oral Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Chenchen Zhou
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ziyang Hu
- Department of Oral Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Zuyan Zhang
- Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yong Cheng
- Department of Oral Radiology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong He
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hu Wang
- Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Gang Li
- Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jun Guo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Radiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Weihua Guo
- Yunnan Key Laboratory of Stomatology, The Affiliated Hospital of Stomatology, School of Stomatology, Kunming Medical University, Kunming, China
| | - Xiaobing Li
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Guangning Zheng
- Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zhimin Li
- Department of Oral Radiology, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Donglin Zeng
- Department of Oral and Maxillofacial Radiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yan Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yuehua Liu
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
| | - Min Hu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Lunguo Xia
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Jihong Zhao
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yaling Song
- Department of Geriatric Dentistry, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Huang Li
- Department of Orthodontics, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Jun Ji
- Department of Orthodontics, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
| | - Lili Chen
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
| | - Tiemei Wang
- Department of Oral Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China.
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Tan Y, Tian Y, Yang M, Lv X, Xiong X. A Commentary on "The Association Between Specific Oral Behaviors and the Number of Temporomandibular Disorder Symptoms in the General Population: A Cross-Sectional Study" [Response to Letter]. J Pain Res 2025; 18:783-784. [PMID: 39991520 PMCID: PMC11847409 DOI: 10.2147/jpr.s519992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 02/14/2025] [Indexed: 02/25/2025] Open
Affiliation(s)
- Yanyue Tan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Yihong Tian
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Ming Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Xiayang Lv
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Xin Xiong
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
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Xiong Y, Yap AU, Marpaung C, Wong MCM. The Depression, Anxiety, Stress Scales-21: Principal component analysis and evaluation of abbreviated versions in young adults with temporomandibular disorders. PLoS One 2025; 20:e0316703. [PMID: 39869552 PMCID: PMC11771923 DOI: 10.1371/journal.pone.0316703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 12/16/2024] [Indexed: 01/29/2025] Open
Abstract
BACKGROUND The Depression, Anxiety, Stress Scales-21 (DASS-21) contain three subscales measuring depression, anxiety, and stress. Several abbreviated DASS-21 versions have been developed, demonstrating better clinical utility and measurement properties than the original instrument. This study explored the factor structure of various abbreviated DASS-21 versions and identified/validated the optimal one for assessing young adults with temporomandibular disorders (TMDs). METHODS A total of 974 university-attending young adults were recruited in two waves (wave 1: 519; wave 2: 455). Demographic information, the DASS-21, and quintessence five TMD symptoms (5Ts) of the Diagnostic Criteria for TMDs were collected. Principal component analysis (PCA) was employed to condense the DASS-21 (wave 1 data), while confirmatory factor analysis (CFA) was used to determine maximum likelihood estimates and compare different abbreviated DASS-21 versions (wave 2 data). Known-group, concurrent (criterion) validity and reliability were subsequently evaluated. RESULTS The mean age of the study participants was 21 (SD = 0.1) years and 80.4% were women. Twelve DASS-21 items were identified from the PCA. However, the Korean DASS-12 provided the best-fit model (χ2/df = 2.07, CFI = 0.975, TLI = 0.960, RMSEA = 0.049, SRMR = 0.033) among the seven abbreviated versions in the CFA. The Korean DASS-12 showed good known-group and concurrent (rs = 0.959) validity and reliability when contrasted to the DASS-21. CONCLUSION The Korean DASS-12 possessed a good fit, known-group, as well as concurrent (criterion) validity and reliability, and was the best abbreviated DASS-21 version for screening young adults with TMD symptoms for psychological distress.
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Affiliation(s)
- Yinghao Xiong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Adrian Ujin Yap
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore, Singapore
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - May Chun Mei Wong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
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Dong Y, Zhou X, Xiang J, Zheng Y, Zheng Y, Xiong X, Wang J. The Association Between Insomnia and Temporomandibular Disorders in Orthodontic Patients. J Pain Res 2025; 18:243-254. [PMID: 39846003 PMCID: PMC11752927 DOI: 10.2147/jpr.s499428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 01/07/2025] [Indexed: 01/24/2025] Open
Abstract
Objective This cross-sectional study aimed to investigate the association between insomnia and the presence of temporomandibular disorders (TMD) and its subtypes in orthodontic patients. Methods A total of 648 adult orthodontic patients (158 males and 490 females, median age 26) were included and completed a questionnaire containing sociodemographic information, insomnia severity index (ISI), the five major temporomandibular disorder symptoms (5Ts) checklist, and self-reported sleep bruxism. Presence of insomnia and TMD of the included patients was determined according to the diagnostic criteria, and statistical analyses were conducted as appropriate to compare ISI-related scores between TMD and non-TMD participants. Further, multivariable regressions were performed to detect the potential correlation between insomnia and TMD in orthodontic patients. Results Orthodontic patients with TMD scored significantly higher in both the individual items and the total sum of ISI than those without TMD. More patients were bothered by insomnia in the TMD group than the non-TMD counterparts (26.6% vs 16.7%, p=0.003). After adjusting for confounding variables, insomnia was found to be significantly correlated with TMD in orthodontic patients (OR=1.677, 95% CI 1.128, 2.511). Subgroup analysis of TMD subtypes showed a significant positive association of insomnia with pain-related TMD (OR=2.007, 95% CI 1.331, 3.015). Conclusion Insomnia was associated with a higher prevalence of pain-related TMD rather than intra-articular TMD in orthodontic patients.
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Affiliation(s)
- Yanhua Dong
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xueman Zhou
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jie Xiang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yunhao Zheng
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yingcheng Zheng
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xin Xiong
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jun Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Zhang S, Sun R, Si J, Xiong X. A Commentary on "Association Between Oral Behaviors and Painful Temporomandibular Disorders: A Cross-Sectional Study in the General Population" [Response to Letter]. J Pain Res 2024; 17:4073-4074. [PMID: 39650208 PMCID: PMC11624681 DOI: 10.2147/jpr.s507568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 11/26/2024] [Indexed: 12/11/2024] Open
Affiliation(s)
- Shuyuan Zhang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ruonan Sun
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jiarui Si
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xin Xiong
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Cui Y, Kang F, Li X, Shi X, Zhang H, Zhu X. Predicting temporomandibular disorders in adults using interpretable machine learning methods: a model development and validation study. Front Bioeng Biotechnol 2024; 12:1459903. [PMID: 39564100 PMCID: PMC11573567 DOI: 10.3389/fbioe.2024.1459903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 10/23/2024] [Indexed: 11/21/2024] Open
Abstract
Introduction Temporomandibular disorders (TMD) have a high prevalence and complex etiology. The purpose of this study was to apply a machine learning (ML) approach to identify risk factors for the occurrence of TMD in adults and to develop and validate an interpretable predictive model for the risk of TMD in adults. Methods A total of 949 adults who underwent oral examinations were enrolled in our study. 5 different ML algorithms were used for model development and comparison, and feature selection was performed by feature importance ranking and feature decreasing methods. Several evaluation indexes, including the area under the receiver-operating-characteristic curve (AUC), were used to compare the predictive performance. The precision-recall curve (PR), calibration curve, and decision curve analysis (DCA) further assessed the accuracy and clinical utility of the model. Results The performance of the random forest (RF) model was the best among the 5 ML models. An interpretable RF model was developed with 7 features (gender, malocclusion, unilateral chewing, chewing hard substances, grinding teeth, clenching teeth, and anxiety). The AUCs of the final model on the training set, internal validation set, and external test set were 0.892, 0.854, and 0.857, respectively. Calibration and DCA curves showed high accuracy and clinical applicability of the model. Discussion An efficient and interpretable TMD risk prediction model for adults was successfully developed using the ML method. The model not only has good predictive performance, but also enhances the clinical application value of the model through the SHAP method. This model can provide clinicians with a practical and efficient TMD risk assessment tool that can help them better predict and assess TMD risk in adults, supporting more efficient disease management and targeted medical interventions.
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Affiliation(s)
- Yuchen Cui
- Department of Orthodontic, Hospital of Stomatology, Jilin University, Changchun, Jilin Province, China
| | - Fujia Kang
- Department of Orthodontic, Hospital of Stomatology, Jilin University, Changchun, Jilin Province, China
| | - Xinpeng Li
- Department of Orthodontic, Hospital of Stomatology, Jilin University, Changchun, Jilin Province, China
| | - Xinning Shi
- Department of Orthodontic, Hospital of Stomatology, Jilin University, Changchun, Jilin Province, China
| | - Han Zhang
- Department of Orthodontic, Hospital of Stomatology, Jilin University, Changchun, Jilin Province, China
| | - Xianchun Zhu
- Department of Orthodontic, Hospital of Stomatology, Jilin University, Changchun, Jilin Province, China
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Tian Y, Tan Y, Yang M, Lv X, Zheng Y, Zhang Q, Sun Y, Wang J, Xiong X. The Association Between Specific Oral Behaviors and the Number of Temporomandibular Disorder Symptoms in the General Population: A Cross-Sectional Study. J Pain Res 2024; 17:3565-3575. [PMID: 39526075 PMCID: PMC11546145 DOI: 10.2147/jpr.s490269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 10/26/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVE This study aimed to thoroughly explore the relationship between individual oral behavior and the differing numbers of temporomandibular disorder (TMD) symptom in the general population. METHODS A total of 565 participants were recruited and completed a questionnaire containing demographic characteristics, eight specific oral behaviors, and five major TMD symptoms (5Ts) checklist. Multivariate linear regression analysis was performed to assess the relationship between individual oral behavior and the number of TMD symptoms, after controlling for confounders. RESULTS The prevalence of TMD symptoms was up to 38.2% in the general population, with 64.6% of the participants engaging in one or more oral behaviors. Female participants showed a stronger positive association with most oral behaviors than males. Moreover, wake oral behaviors exhibited a higher correlation coefficient value with TMD symptom number than sleep oral behaviors. Among the eight oral behaviors, bruxism in sleep exhibited no significant correlation with the of TMD symptom number (P>0.05). Seven other specific oral behaviors were significantly correlated with the number of TMD symptoms by multivariate linear regression analysis (P<0.01). The associations between the seven oral behaviors and TMD symptom number remained significant in sleep posture pressuring jaw (β: 0.165, 95% CI: 0.080-0.250), bruxism in awake (β: 0.341, 95% CI: 0.132-0.550), teeth clenching (β: 0.422, 95% CI: 0.264-0.580), pressing, holding, or touching teeth together (β: 0.282, 95% CI: 0.169-0.395), holding or tightening muscles without clenching (β: 0.447, 95% CI0.304-0.589), holding jaw forward or to the side (β: 0.694, 95% CI0.526-0.861), and holding jaw in rigid or tense position (β: 0.571, 95% CI0.418, 0.724) after adjustment for demographic factors (P<0.01). CONCLUSION There was a positive association between seven specific oral behaviors and TMD symptom number. Individuals with higher frequency of specific oral behaviors are more likely to suffer from more TMD symptoms. Sleep bruxism exhibited no association with TMD symptoms and symptom number.
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Affiliation(s)
- Yihong Tian
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, People’s Republic of China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yanyue Tan
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ming Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, People’s Republic of China
| | - Xiayang Lv
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yunhao Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, People’s Republic of China
| | - Qiang Zhang
- Department of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Yanyu Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, People’s Republic of China
| | - Jun Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, People’s Republic of China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xin Xiong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, People’s Republic of China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Liu CG, Yap AU, Fu KY, Lei J. The "5Ts" screening tool: Enhancements and threshold values for effective TMD identification. Oral Dis 2024; 30:4495-4503. [PMID: 38287488 DOI: 10.1111/odi.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE This study aimed to enhance the quintessential "five temporomandibular disorder (TMD) symptoms" (5Ts) screener by incorporating frequency options and distinguishing between TMJ and muscle pain. The diagnostic accuracy along with cut-off points for the effective identification of TMDs was also established. METHODS Participants, aged ≥18 years, were recruited from a university-based hospital. After completing surveys encompassing demographic data and the enhanced 5Ts (with frequency options [5Ts-F] and differentiation of TMJ/muscle pain [6Ts-F]), protocolized interviews and clinical examinations were performed following DC/TMD. The diagnostic accuracy and best cut-off points were determined with the area under the receiver operating characteristic curves (AUCs). RESULTS 324 participants were recruited (mean age 30.0 ± 11.4 years). Among these, 86.4% had TMDs. 5Ts exhibited high diagnostic accuracy for detecting all TMDs (AUC = 0.92) with sensitivity/specificity values of 83.9%/88.6%. Both 5Ts-F and 6Ts-F had slightly better accuracy (AUCs = 0.95/0.96), comparable sensitivity, and superior specificity (97.7%) compared to 5Ts. The best cut-off points were 1.5 for 5Ts and 2.5 for 5Ts-F/6Ts-F. CONCLUSIONS Although all three TMD screeners presented high diagnostic accuracy, 5Ts-F/6Ts-F had notably improved specificity. 5Ts scores of >1.5 and 5Ts-F/6Ts-F scores of >2.5 are to be applied for screening the presence of TMDs.
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Affiliation(s)
- C G Liu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - A U Yap
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Dentistry, Ng Teng Fong General Hospital, and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore
| | - K Y Fu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - J Lei
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, China
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11
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Yap AU, Lai YC, Ho HCW. Prevalence of temporomandibular disorders and their associated factors in Confucian heritage cultures: A systematic review and meta-analysis. J Oral Rehabil 2024; 51:2169-2194. [PMID: 38873743 DOI: 10.1111/joor.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/12/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
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.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore
| | - Ye Choung Lai
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
| | - Henry Chee Wai Ho
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
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12
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Yap AU, Tan SHX. Conceptualising TMD symptom burden in youths: Symptom duration, frequency, intensity and interference. J Oral Rehabil 2024; 51:1486-1498. [PMID: 38706175 DOI: 10.1111/joor.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/15/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE This study aimed to conceptualise Temporomandibular disorder (TMD) symptom burden and severity and explored their interrelationships with somatic symptoms and psychological distress. METHODS Participants were recruited from a local polytechnic. The quintessential five TMD symptoms (5Ts) of the Diagnostic Criteria for TMDs (DC/TMD) were appraised and extended to evaluate the duration, frequency, intensity and interference of discrete TMD symptoms. Global TMD severity (GS) was computed by totaling the points for all TMD symptoms and dimensions. TMD (TS) and somatic symptom (SS) burden were assessed based on the Somatic Symptoms Scale-8, while psychological distress was measured with the Depression, Anxiety and Stress Scales-21. Statistical analyses were performed using Kruskal-Wallis/Dunn tests and Spearman's correlation (α = .05). RESULT Of the 366 eligible participants (mean age 19.1 ± 2.3 years), 51.4% were 5Ts-negative and 48.6% were 5Ts-positive. Among the 5Ts-positive individuals, 25.3%/64.0% were 'bothered a little' whereas 4.5%/10.7% were 'bothered a lot' by TMD pain/headache. Correspondingly, 32.6%/12.4%/5.1% were 'bothered a little' while 2.8%/2.8%/1.1% were 'bothered a lot' by TMJ sounds/closed/open locking. TS burden was moderate-to-strongly correlated to aggregate symptom duration, frequency, intensity, interference, GS and SS burden (rs = .50-.88). While TS burden and GS were weakly associated with psychological distress (rs = .18-.36), SS burden was moderately related to depression, anxiety and stress (rs = .47-.53). CONCLUSIONS TS burden can serve as a proxy for global TMD severity and may be more meaningful than the mere presence of TMD symptoms in clinical and research settings.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, National Dental Research Institute Singapore, Singapore, Singapore
| | - Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Ujin Yap A, Kurniawan F, Pragustine Y, Marpaung C. Temporomandibular disorder and somatic symptoms: Relations to 'fear of missing out' and other negative emotional states. Acta Odontol Scand 2024; 83:340-347. [PMID: 38804261 PMCID: PMC11302401 DOI: 10.2340/aos.v83.40776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The association between the 'fear of missing out (FOMO)' and physical symptoms has not been widely explored. This study aimed to investigate the relationship between FOMO and other negative emotions with Temporomandibular disorder (TMD) and somatic symptoms in young adults. The correlations between the various physical and emotional variables were also established. MATERIAL AND METHODS TMD and somatic symptoms were appraised with the Short-form Fonseca Anamnestic Index, quintessential five TMD symptoms of the Diagnostic Criteria (DC)/TMD, and Patient Health Questionnaire-15. FOMO and other negative emotional states were assessed with the FOMO Scale and Depression, Anxiety, Stress Scales-21 (DASS-21). Data were evaluated using non-parametric tests/correlation and regression analysis (α = 0.05). RESULTS While only negative affectivity (total DASS), anxiety, and stress differed significantly between those without and with TMDs, significant variances in FOMO and all DASS-21 constructs were discerned between individuals without and with somatization. Conclusions: Individuals with orofacial pain and more severe somatic symptoms have higher levels of negative emotions including FOMO. While somatization increased the prospect of TMDs, being female, presence of TMDs, and negative affectivity were risk factors for somatization in young adults. CLINICAL RELEVANCE Asian young adults appear to be disposed to somatization, and TMDs may be a form of functional somatic syndromes. Recognition of somatic symptoms and emotional distress, including FOMO, is essential for person-centric TMD care.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore; National Dental Research Institute Singapore, National Dental Center Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore; Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Florencia Kurniawan
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Yenny Pragustine
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia.
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Yap AU, Dewi NL, Marpaung C. Comorbidities between temporomandibular disorders and somatization in young adults: exploring links with personality, emotional, and sleep disturbances. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:493-500. [PMID: 38480071 DOI: 10.1016/j.oooo.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/07/2023] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The comorbidities between temporomandibular disorders (TMDs) and somatization and their associations with personality traits, emotional disorders, and sleep disturbances were investigated. STUDY DESIGN Adults aged 18 to 24 years completed an electronic survey encompassing TMD symptoms (5Ts), Patient Health Questionnaire-15, Big Five Personality Inventory-10, Depression Anxiety Stress Scales-21, and Pittsburgh Sleep Quality Index. Data were assessed using non-parametric tests/correlation analysis and logistic regression analysis (α = 0.05). RESULTS The sample comprised 365 participants, of whom 22.2% and 19.5% were 5Ts-negative without and with somatization, respectively, and 18.1% and 40.3% were 5Ts-positive without and with somatization, respectively. Significant differences in neuroticism, distress, depression, anxiety, stress, and sleep quality were observed between 5Ts-negative participants with somatization and 5Ts-positive participants with somatization compared with 5Ts-negative participants without somatization and 5Ts-positive participants without somatization. Distress, anxiety, stress, and sleep were moderately correlated with somatic but not TMD symptoms (rs = 0.45-0.52). CONCLUSIONS Irrespective of whether they had TMDs, participants with somatization exhibited heightened levels of neuroticism and emotional and sleep disturbances.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia; Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore; National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, SingHealth, Singapore
| | - Ni Luh Dewi
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia.
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Ye C, Pu D, Zhang J, Jia M, Zhang Y, Du S, Wang J, Xiong X. Unlocking the link between temporomandibular disorders and suicide ideation in pre-orthodontic patients: A moderated mediation model of depression and anxiety. J Affect Disord 2024; 349:486-493. [PMID: 38199395 DOI: 10.1016/j.jad.2024.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are a series of musculoskeletal diseases with high prevalence. A few studies have reported the correlation between TMD and suicide ideation (SI). However, the underlying mechanism of the relationship lacks in-depth exploration. METHODS A cross-sectional study was conducted among 954 pre-orthodontic patients. TMD assessment was based on the quintessential five TMD symptoms (5Ts) questionnaire. Anxiety, depression and pain catastrophizing was evaluated by Seven-item Generalized Anxiety Disorder Scale (GAD-7), Nine-item Patient Health Questionnaire (PHQ-9), and Pain Catastrophizing Scale (PCS), respectively. Correlational and moderated mediated analysis was preformed to demonstrate the relationship between TMD and SI. RESULTS In pre-orthodontic patients, 31.87 % reported having TMD symptoms and 6.50 % declared SI during the past two weeks. The SI prevalence was 10.53 % in participants with TMD and 4.62 % in those without TMD. Intra-articular TMD, rather than pain-related TMD were especially related with SI. Individuals with TMD had higher risk to SI (rs = 0.112, adjusted OR = 2.213, p < 0.001). The effect of TMD on SI was fully mediated through depression (β = 0.445, 95 % CI = [0.326, 0.563]). Anxiety exerted a negative moderating effect on the depression-SI relation (β = -0.033, 95 % CI = [-0.047, -0.019]). LIMITATIONS This study was a single-centered and cross-sectional survey. The data collection relied on self-reporting methods. CONCLUSIONS A positive link between TMD and SI was disclosed. The effect of TMD on SI was fully mediated through depression with anxiety as a negative moderator.
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Affiliation(s)
- Chengxinyue Ye
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Dan Pu
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jie Zhang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Mao Jia
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yuyao Zhang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Shufang Du
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jun Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Xiong
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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16
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Yap AU, Wee KK, Loh JY, Marpaung C, Natu VP. Temporomandibular disorder pain in older adolescents-young adults: Interrelationship with somatic burden, mental ill-being, and well-being. Cranio 2024:1-11. [PMID: 38415618 DOI: 10.1080/08869634.2024.2322595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES The associations of Temporomandibular disorder (TMD) pain with somatic symptoms, mental ill-being/distress, and well-being were explored, along with the mental correlates of TMD (TS) and somatic symptom (SS) burden in older adolescents-young adults. METHODS TMD/somatic symptoms were appraised with the five quintessential symptoms (5Ts) of the DC/TMD/Somatic Symptom Scale-8, whereas mental distress/well-being was assessed with the Depression, Anxiety, Stress Scales-21/Scales of Psychological Well-being-18. Data were examined using Chi-square/non-parametric tests and multivariate analyses (α = .05). RESULTS Among the 366 participants, 51.4%, 28.1%, 6.8%, and 13.7% had no TMD (NT), TMD pain (TP), TMD dysfunction (TD), and combined TMD (CT) respectively. Though mental distress varied substantially (CT, TP>NT, TD), no significant differences in well-being were discerned. SS burden, but not TS burden, was moderately correlated to distress. CONCLUSIONS The prospect of TMD pain was increased by being female, depressed, and anxious but reduced by "positive relations with others" and "self-acceptance".
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore
- National Dental Research Institute Singapore, National Dental Center Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore
| | - Kai Kee Wee
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore
| | - Jia Yu Loh
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
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Sun R, Zhang S, Si J, Zhang L, Yang H, Ye Z, Xiong X. Association Between Oral Behaviors and Painful Temporomandibular Disorders: A Cross-Sectional Study in the General Population. J Pain Res 2024; 17:431-439. [PMID: 38328021 PMCID: PMC10848921 DOI: 10.2147/jpr.s449377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Studies have reported correlations between various oral behaviors and painful temporomandibular disorders (TMD), yet comprehensive research on the independent effects of each oral behavior within the general population remains sparse. OBJECTIVE This cross-sectional study aimed to investigate the association between painful TMD (PT) and various oral behaviors in general population. METHODS A questionnaire survey was conducted with participants to collect data encompassing demographic characteristics, eight specific oral behaviors, and the 5 major TMD symptoms(5Ts) checklist. Participants were categorized into PT and non-PT (NPT) groups based on their responses to the 5Ts checklist. Those reporting TMJ/facial pain or headaches were assigned to the PT group, while all other participants constituted the NPT group. Both univariate and multivariate logistic regression analyses were employed to evaluate the association between individual oral behavior and the presence of PT, controlling for demographic confounders including age, sex, systemic diseases, and dental treatments history. RESULTS A total of 441 valid questionnaires were received, including 156 males and 285 females. The prevalence of PT was identified to be 33.33%, with 61.00% of participants engaging in one or more types of oral behaviors. Each oral behavior was more frequently reported in the PT group compared to the NPT group. The univariate logistic regression analysis identified positive correlations between all eight oral behaviors and PT. In the multivariate logistic regression analysis, these associations persisted after adjustment for demographic confounders including age, sex, history of systemic diseases and dental treatments (P<0.01). The behaviors most strongly associated with PT were "Hold or jut jaw forward/to the side" (OR:4.478), "Hold, tighten or tense muscles without clench" (OR:3.343) and "Hold jaw in rigid or tense position" (OR:3.209). CONCLUSION The presence of oral behaviors has significant association with PT. Individuals exhibiting multiple oral behaviors are more likely to experience PT. Additional studies are needed to clarify the effects of reducing oral behaviors on pain-related symptoms.
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Affiliation(s)
- Ruonan Sun
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Shuyuan Zhang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jiarui Si
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Liming Zhang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Haolun Yang
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zheng Ye
- West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xin Xiong
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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18
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Yap AU, Lei J, Zhang XH, Fu KY. TMJ degenerative joint disease: relationships between CBCT findings, clinical symptoms, and signs. Acta Odontol Scand 2023; 81:562-568. [PMID: 37211630 DOI: 10.1080/00016357.2023.2215317] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The relationships between cone-beam computed tomography (CBCT) findings, Temporomandibular disorder (TMD) symptoms, and signs were investigated in patients with TMJ degenerative joint disease (DJD). MATERIAL AND METHODS Adult patients with Diagnostic Criteria for TMDs (DC/TMD)-defined intra-articular conditions were enrolled and subjected to CBCT assessment. The participants were organized into three groups, namely no (NT), early (ET), and late (LT) TMJ DJD based on radiographic findings. TMD symptoms/signs were appraised using the DC/TMD methodology. Statistical analyses were performed using Chi-square/non-parametric tests and Kappa statistics (α = 0.05). RESULTS The mean age of the participants (n = 877) was 30.60 ± 11.50 years (86.6% women). NT, ET, and LT were observed in 39.7%, 17.0%, and 43.3% of the study sample. Significant differences in the prevalence of TMD symptoms (TMD pain, TMJ sounds, opening, and closing difficulty) and signs (TMD/TMJ pain, TMJ clicking/crepitus, and opening limitation) were discerned among the three groups (p ≤ .001). TMD/TMJ pain and opening difficulty/limitation were more prevalent in early rather than late degenerative changes. While moderate agreements between symptoms and signs were observed for TMD pain/opening limitation, the concurrence for TMJ sounds was fair. CONCLUSIONS Young adults with TMJ sounds and pain should be examined with CBCT to establish the extent/progress of osseous changes.
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Affiliation(s)
- Adrian Ujin Yap
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, P.R. China
- Department of Dentistry, Ng Teng Fong General Hospital, and Faculty of Dentistry, National University Health System, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore
| | - Jie Lei
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, P.R. China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, P.R. China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, P.R. China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, P.R. China
- Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China
| | - Xiao-Han Zhang
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, P.R. China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, P.R. China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, P.R. China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, P.R. China
- Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China
| | - Kai-Yuan Fu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, P.R. China
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, P.R. China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, P.R. China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, P.R. China
- Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China
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Yap AU, Marpaung C. Personality, psychosocial and oral behavioural risk factors for temporomandibular disorder symptoms in Asian young adults. J Oral Rehabil 2023; 50:931-939. [PMID: 37256928 DOI: 10.1111/joor.13527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/16/2023] [Accepted: 05/28/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The relation between personality, psychosocial factors, somatisation, andoral behaviours as risk factors to temporomandibular disorder symptoms have notbeen well established. OBJECTIVES This study examined the association of temporomandibular disorder (TMD) symptoms with personality traits, psychological distress, somatisation and oral behaviours. The psychosocial and oral behavioural risk factors for TMD symptoms were also established in Asian young adults. METHODS Participants were recruited from a large private University. Based on the quintessential five TMD symptoms (5Ts) of the DC/TMD, the participants were stratified into those with no (NT), painful (PT), dysfunctional (DT) and mixed (MT) TMD symptoms. Personality traits, psychological distress, somatisation and oral behaviours were evaluated with the Big Five Inventory-10 (BFI-10), Depression, Anxiety, Stress Scales-21 (DASS-21), Patient Health Questionnaire-15 (PHQ-15) and Oral Behaviours Checklist (OBC) accordingly. Data were examined using Kruskal-Wallis/Mann-Whitney U and Chi-squared tests, as well as multivariate logistic regression analysis (α = .05). RESULTS Of the 420 young adults (mean age 22.7 ± 1.1 years) evaluated, 41.4% had no TMD symptoms, while 17.4%, 20.0% and 21.2% reported PT, DT and MT, respectively. Though personality traits did not vary notably, participants with MT and PT had significantly higher levels of negative affectivity, anxiety and stress than the NT group. Moreover, those with MT and PT presented significantly greater somatisation and more oral behaviours than the DT and NT groups. Multivariate regression analyses indicated that anxiety, somatisation, sleep-related and waking-state nonfunctional oral activities were associated with painful and/or dysfunctional TMD symptoms. CONCLUSIONS Except for sleep-related oral activity, psychosocial and oral behavioural risk factors differed for painful, dysfunctional and mixed TMD symptoms in Asian young adults.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore City, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore City, Singapore
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
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Psychological Profiles and Their Relevance with Temporomandibular Disorder Symptoms in Preorthodontic Patients. Pain Res Manag 2022; 2022:1039393. [PMID: 36247102 PMCID: PMC9553652 DOI: 10.1155/2022/1039393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/03/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022]
Abstract
Background Temporomandibular disorders (TMDs) refer to a group of heterogenous musculoskeletal diseases with diverse clinical symptoms and an undetermined aetiology. The psychological profiles were closely related to the onset and treatment outcomes of TMDs. Objective To examine the relevance between psychological profiles and different symptoms of TMDs in preorthodontic patients. Methods The study was conducted among 570 preorthodontic patients. TMDs symptoms were recorded by the Diagnostic Criteria for TMD (DC/TMD) symptom questionnaire. The seven-item Generalized Anxiety Disorder Scale (GAD-7), the nine-item Patient Health Questionnaire (PHQ-9), and the Pain Catastrophizing Scale (PCS) were used for the evaluation of anxiety, depression, and pain catastrophizing levels. The relevance of three psychological profiles with TMDs and subtypes was evaluated with Spearman's rank correlation test and logistic regression analysis (P < 0.05). Results 34.56% of the enrolled preorthodontic patients were diagnosed with TMDs. Scores of GAD-7, PHQ-9, and PCS were significantly higher in the TMDs group than in the non-TMDs group. Participants with anxiety, depression, or high pain catastrophizing had a higher prevalence of both pain-related TMDs symptoms and intra-articular TMDs symptoms. The correlations among pain-related TMDs, intra-articular TMDs, and scores on the psychological scales were significant (P < 0.05). The adjusted logistic regression model revealed that anxiety, depression, and high pain catastrophizing were significant risk factors for TMDs with an odds ratio (OR) of 2.196, 1.741, and 1.601, respectively. Depression was associated with higher pain-related TMDs prevalence (OR = 2.136), while anxiety and depression were associated with higher intra-articular TMDs prevalence (OR = 2.341 and 1.473). Conclusion Anxiety, depression, and high pain catastrophizing were comorbid psychological conditions of TMDs. Depression was the top risk factor for pain-related TMDs, while anxiety rendered the highest risk for intra-articular TMDs. Inclusion of psychological assessments in preorthodontic evaluation might yield great benefits in TMDs screening.
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Yap AU, Tan SHX, Marpaung C. Temporomandibular disorder symptoms in young adults: Three‐dimensional impact on oral health‐related quality of life. J Oral Rehabil 2022; 49:769-777. [DOI: 10.1111/joor.13340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/27/2022] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry National University Health System Singapore
- National Dental Research Institute Singapore National Dental Centre Singapore and Duke‐NUS Medical School Health Services Singapore Singapore
- Department of Prosthodontics, Faculty of Dentistry Trisakti University Indonesia
- School of Health & Social Sciences (Oral Health Therapy) Nanyang Polytechnic Singapore
| | - Sharon Hui Xuan Tan
- School of Health & Social Sciences (Oral Health Therapy) Nanyang Polytechnic Singapore
- Saw See Hock School of Public Health National University of Singapore Singapore
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry Trisakti University Indonesia
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