Stress in patients with pain in the muscles of mastication and the temporomandibular joints

Elevation of histidine decarboxylase activity in skeletal muscles and stomach in mice by stress and exercise

The effects of different types of stress (water bathing, cold, restraint, and prolonged walking) on histidine decarboxylase (HDC) activity in masseter, quadriceps femoris, and pectoralis superficial muscles, and in the stomach were examined in mice. All of these stresses elevated gastric HDC activity. Although water bathing, in which muscle activity was slight, was sufficiently stressful to produce gastric hemorrhage and to increase gastric HDC activity, it produced no detectable elevation of HDC activity in any of the muscles examined. The other stresses all elevated HDC activity in all three muscles. We devised two methods of restraint, one accompanied by mastication and the other not. The former elevated HDC activity in the masseter muscle, but the latter did not. These results suggest that 1) HDC activity in the stomach is an index of responses to stress, 2) the elevation of HDC activity in skeletal muscles during stress is induced partly or wholly by muscle activity and/or muscle tension, and 3) stress itself does not always induce an elevation of HDC activity in skeletal muscles.

Temporomandibular and cervical spine disorders. Self-reported signs and symptoms

STUDY DESIGN

The authors assessed the results of an anamnestic self-administered questionnaire given to 111 patients with temporomandibular disorders and 103 patients with cervical spine disorders.

OBJECTIVES

The present study was performed to investigate whether patients with cervical spine disorders and subgroups of patients with temporomandibular disorders differ regarding specific and accompanying signs and symptoms of temporomandibular disorders and cervical spine disorders.

SUMMARY OF BACKGROUND DATA

Patients with temporomandibular disorders frequently show signs and symptoms related to cervical spine disorders, and, vice versa, patients with cervical spine disorders may show signs and symptoms related to temporomandibular disorders. Many authors have pointed out the existence of neuroanatomical and biomechanical relationships.

METHODS

The questionnaire included questions about pain, symptoms of temporomandibular disorders, accompanying signs and symptoms, psychosocial factors, and general health. Before their clinical examination, all patients were requested by mail to complete the questionnaire.

RESULTS

Patients with cervical spine disorders reported fewer symptoms of temporomandibular disorders than the subgroups of patients with temporomandibular disorders, more general health symptoms than patients with temporomandibular disorders with an arthrogenous or myogenous component, and fewer ear symptoms than patients with temporomandibular disorders. There was no difference between the patient groups regarding other associated signs and symptoms and psychosocial factors as measured with the questionnaire. Logistic regression analyses showed that six variables (jaws, ears, eyes, temporomandibular joint sounds, complaints of the shoulders, and pain in joints other than the temporomandibular joint) correctly classified 91% of the patients as having temporomandibular disorders or cervical spine disorders.

CONCLUSIONS

The results of this study do not support the theoretical concept that cervical spine disorders may give rise to temporomandibular disorders. The authors' results indicate that the anamnestic questionnaire can be used as an aid to distinguish patients with cervical spine disorders from subgroups of patients with temporomandibular disorders.

Multidimensional evaluation of craniomandibular dysfunction. I: Symptoms and correlates

To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about (i) pain, (ii) other symptoms of CMD, (iii) correlates of CMD, (iv) psychosocial factors, and (v) general health. Variables discriminating between subgroups of clinical cases and controls were described successively. This study was performed to assess whether subgroups of patients with signs and symptoms of craniomandibular dysfunction (CMD), and a control group of dental patients with and without signs and symptoms of CMD, can be characterized by differential report of signs and symptoms of CMD, as reported in Screen. Results indicate that Screen can be used to discriminate between (i) subgroups of subjects with signs or symptoms of CMD (both clinical cases and controls) and controls without signs or symptoms of CMD; (ii) subgroups of clinical cases and controls with signs and/or symptoms of CMD; and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component, and with regard to the subjective treatment need for CMD. The results of logistic regression analyses indicate that subsets of items of Screen correctly classified up to 80% of patients with myogenous or arthrogenous CMD. Implications for further research were discussed.

Psychosocial aspects of craniomandibular dysfunction. An assessment of clinical and community findings

This study was performed to assess whether subgroups of patients with signs and symptoms of craniomandibular dysfunction (CMD) and a control group of dental patients with and without signs of CMD can be characterized by psychosocial variables, and whether there is evidence of stress-induced muscle hyperactivity as a contributing factor in the development of signs and symptoms of CMD. A group of 127 care-seeking patients and a control group of 158 dental patients completed a Questionnaire Battery (QB) designed to measure external stressors, stress-related emotional reactions (anxiety and depression) and personal factors such as coping styles, health locus of control and personality. Patients with CMD with both a myogenous and an arthrogenous component reported more stress and stronger stress-related emotional reactions than patients with either an arthrogenous or a myogenous CMD. However, patients with arthrogenous CMD did not differ on psychosocial variables from patients with myogenous CMD. In contrast to expectations, controls with signs of CMD reported more stress than patients with CMD. Compared with controls, CMD-patients experienced less personal control over their health and they considered health to be determined by chance or fate. CMD-patients also reported to cope differently with stress than controls. Analyses of covariance showed that the results were not influenced by differences in age, sex or pain reported in the head, neck and/or shoulders. Results were interpreted with regard to the psychophysiological theory of the development of signs and symptoms of CMD as a consequence of the progression of stress-induced muscle hyperactivity. Differences between patients and controls in personal factors were interpreted with regard to treatment need for CMD.