Determination of pain intensity, pain-related disability, anxiety, depression, and perceived stress in Polish adults with temporomandibular disorders: A prospective cohort study

The Relationship Between Anxiety and Masseter Muscle in Temporomandibular Disorders: An Ultrasonographic Assessment

OBJECTIVE

This study aimed to investigate the effects of temporomandibular disorders and anxiety on masseter muscle morphology using ultrasonography, considering gender and chewing side preference.

METHODS

A total of 93 participants, including 67 patients with unilateral disc displacement and 27 healthy controls, were evaluated. Anxiety levels were assessed using the Beck Anxiety Inventory, while temporomandibular disorder severity was determined by the Fonseca Anamnestic Index. Masseter muscle thickness, length, and cross-sectional area were measured bilaterally at rest and during intercuspation using a high-frequency linear probe. Statistical analyses were conducted based on temporomandibular disorder severity, anxiety, gender, and chewing side preference.

RESULTS

Participants with disc displacement exhibited significantly increased masseter thickness on the affected side at both rest and intercuspation (p < 0.05), whereas muscle length and cross-sectional area remained unchanged. Individuals with severe anxiety had a significantly greater cross-sectional area compared to those with normal anxiety (p < 0.05), while thickness and length showed no significant differences. Males had significantly greater masseter thickness, length, and cross-sectional area than females (p < 0.05). No significant differences were found concerning chewing side preference (p > 0.05).

CONCLUSION

Temporomandibular disorders and anxiety influence masseter morphology, with variations based on severity and duration. Gender differences were evident, whereas chewing side preference had no significant effect. Ultrasonography proves to be a reliable tool for masseter evaluation, though future studies should incorporate advanced imaging and functional assessments.

Evaluation of the relationship between bruxism and/or temporomandibular disorders and stress, anxiety, depression in adults: A systematic review and qualitative analysis

OBJECTIVE

The objective of this study was to map and systematically review the available evidence regarding the relationship between bruxism and/or temporomandibular disorders, psychological factors (stress, anxiety, depression) in adults.

MATERIAL AND METHOD

A systematic review has been conducted following the criteria described in Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). A systematic search was performed in the Web of Science database with the last search updated as of November 2024. Observational studies in adults in which bruxism is assessed by questionnaires or clinical examination were included in the search. 10 of the 92 articles met the inclusion and exclusion requirements and were subject to a qualitative analysis.

RESULTS

There seems to be an association between bruxism, temporomandibular disorders and psychological factors. Clenching and grinding may be associated with overload of the chewing structures and give rise to symptoms typical of temporomandibular disorders, all under the probable influence of psychological factors.

CONCLUSIONS

Bruxism, associated with psychological factors, leads to the appearance of symptoms typical of temporomandibular disorders. More research is needed to understand how the factors interact.

CLINICAL SIGNIFICANCE

Clinicians should be aware of the psychological factors associated with bruxism and the relationship with temporomandibular disorders.

Could Traumatic Brain Injury Be a Risk Factor for Bruxism and Temporomandibular Disorders? A Scoping Review

Background/Objectives: Bruxism and temporomandibular disorders (TMDs) are common conditions of the stomatognathic system. Some studies suggest a potential link with traumatic brain injury (TBI), which is gaining increasing interest among researchers. The aim of this scoping review is to map the available evidence on the association between TBI and bruxism or TBI and TMDs. Methods: The review was conducted by analyzing four databases: PubMed, Web of Science, Scopus, and the Cochrane Collaboration database. A total of 340 studies were reviewed in this work, and 4 studies examining the connections between TBI were included in the analysis (with n = 3 focusing on the association between bruxism and TBI, and n = 1 on the association between TMDs and TBI). Results: Analyzing the publications on bruxism and TMDs in relation to TBI, at this stage it can be concluded that there is no solid evidence confirming the impact of TBI on the studied conditions. This is due to the quantity and quality of the collected evidence. Conclusions: In light of the presented review, it must be concluded that the quantity and quality of the evidence are insufficient to assert that TBI is a factor in the onset of bruxism or TMDs. Further research on this phenomenon is recommended, particularly focusing on the effects of different severities of TBI and various regions of brain injury.

Genetic evidence strengthens the connection between emotional disorders and TMD-related pain: A two-sample Mendelian randomization study

OBJECTIVES

This study aims to evaluate the genetic association between emotional disorders and TMD-related pain through two-sample Mendelian randomization analysis.

DESIGN

Single-nucleotide polymorphisms (SNPs) related to emotional disorders (worry, nerves, or depression) were selected from genome-wide association studies (GWAS) from UK Biobank consortia, and related these to SNPs from FinnGen consortia. The inverse-variance weighted (IVW) was used as the primary effect estimate between emotional disorders and TMD-related pain, and various methods were applied to test the reliability and stability of the results, namely MR-Egger and weighted median.

RESULTS

The Mendelian randomization analysis showed that there was a positive correlation between emotional disorders and TMD-related pain, including worry group (IVW odds ratio (OR) = 3.86, 95 % confidence interval (CI) = 1.67-8.91), nerves group (IVW OR = 11.20, 95 % CI=2.04-61.64) and depression group (IVW OR = 3.32, 95 % CI=1.24-8.90). MR-Egger intercept and MR-PRESSO global test did not suggest evidence of horizontal or directional pleiotropy. Cochran's Q test showed that there was no heterogeneity between instrumental variables.

CONCLUSIONS

This study provides genetic evidence that strengthens the connection between emotional disorders and TMD-related pain, which has important implications at the causal level as well as throughout the treatment process of TMD-related pain.

Prevalence of central sensitization and somatization in adults with temporomandibular disorders-a prospective observational study

Temporomandibular disorders (TMD) comprise a group of conditions affecting the masticatory muscles, the temporomandibular joints and associated structures, often manifesting as orofacial pain and functional limitations of the mandible. Central sensitization (CS) is gaining increasing attention in research focused on pain syndromes and somatization, playing a significant role in the pain experience. This study investigates the prevalence of CS and somatization among TMD patients, analyzing their relationships with TMD diagnoses and the intensity of chronic masticatory muscle pain (MMP). A prospective observational study was conducted with 214 adult participants diagnosed with TMD, based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The Central Sensitization Inventory (CSI) and the Somatic Symptom Scale-8 (SSS-8) were utilized to assess CS and the burden of somatic symptoms, respectively. Furthermore, the patients were assessed for MMP, and the average pain in these muscles was calculated. Statistical analysis investigated correlations between CSI and SSS-8 scores, specific TMD diagnoses and MMP intensity. Most participants did not surpass the subclinical level for CS as assessed by the CSI. Women reported higher SSS-8 scores than men, suggesting sex differences in somatic symptom reporting. No significant relationship was found between specific TMD diagnoses and levels of CS or the SSS-8. However, a significant correlation was observed between SSS-8 scores and the intensity of chronic MMP, underscoring the impact of the intensity of chronic MMP on the perception of somatic symptoms among TMD patients. Additionally, the group with subclinical levels of CS presented significantly lower SSS-8 scores than other groups. This study highlights a lower-than-expected prevalence of CS among TMD patients. Higher levels of somatization were related to higher levels of CS and greater MMP. The findings suggest that TMD management should not only address specific pain sources but also consider the broader psychosocial aspects of the disorders, especially in chronic types.

Does salivary cortisol serve as a potential biomarker for temporomandibular disorders in adults?

BACKGROUND

The etiology of temporomandibular disorders (TMD) is multifactorial, involving a complex interplay of psychological and physiological factors. While salivary biomarkers, particularly cortisol, play an important role in TMD pathophysiology, evidence in the literature is still scarce and inconsistent. Hence, this study aims to evaluate the applicability of salivary cortisol as a potential biomarker for TMD in adults.

METHODS

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were used to accurately diagnose TMD patients. The study included adults, both male and female, aged 18-40 in the TMD group (n = 66) and non TMD participants (n = 66) matched for age and gender. Salivary samples were collected from participants at two time points: early and late morning. Cortisol levels in the samples were quantified using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using a one-way ANOVA to evaluate the correlations between cortisol levels and the study variables. Tukey's post-hoc tests were applied to adjust for multiple comparisons.

RESULTS

Salivary cortisol levels were significantly higher in the TMD group than in the corresponding controls (p = 0.034). In the TMD group, the mean cortisol levels early in the morning were 29.95 ± 75.05 (0-398.64), while the late morning levels were recorded as 4.87 ± 3.96 (0-17.13). In the control group, the mean cortisol levels early in the morning were 10.98 ± 16.83 (2.16-92.90), and late morning mean cortisol levels were 6.15 ± 6.13 (0-20.42). This indicates that the early morning levels of cortisol are higher in TMD patients (p = 0.046). In the subgroup analysis of the TMD, the mean salivary cortisol levels recorded were highest at 82.49 ± 124.34 (8.32-398.64) in patients having disc displacement without reduction with limited mouth opening. Furthermore, the mean salivary cortisol levels in the early morning were statistically higher (84.83 ± 132.80) in males compared to females (9.36 ± 9.01) (p = 0.008) with TMD.

CONCLUSION

The result of this study suggests that salivary cortisol could be a potential biomarker for a specific TMD subtype (disc displacement without reduction with limited mouth opening). However, further studies are needed to better understand the role of cortisol biomarker in the underlying pathogenesis of TMD.

The Association Between Specific Oral Behaviors and the Number of Temporomandibular Disorder Symptoms in the General Population: A Cross-Sectional Study

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.

The Potential of Percent Agreement as an Adjunctive Diagnostic Tool for Acute Temporomandibular Disorder

Background/Objectives: It is well established that individuals with chronic temporomandibular disorder (TMD) exhibit differences in their physical and psychosocial characteristics from those with acute TMD. However, few studies have analyzed the physical and psychosocial characteristics of patients with acute TMD. The objective of this cross-sectional study is twofold: first, to ascertain whether there are differences in physical and psychosocial factors among patients with acute TMD based on the percent agreement between patient-reported pain sites and pain sites identified through standardized palpation and, second, to determine the potential of percent agreement as a diagnostic and prognostic factor. Methods: We analyzed physical and psychosocial factors in 309 patients diagnosed with acute TMD. Of these, 171 patients were selected for an analysis of their response to treatment. These patients were divided into three groups based on their percent agreement: Group A (agreement under 80%), Group B (agreement 80-89%), and Group C (agreement 90% or over) in the initial analysis and Group a (agreement under 80%), Group b (agreement 80-89%), and Group c (agreement 90% or over) in the subsequent analysis. This study was approved by the Ethics Committee of Pusan National University Dental Hospital (IRB No. 2023-05-011, 25 May 2023). Results: The lower the percent agreement, the greater the parafunctional oral habits, stress, chronicity, somatization, depression, anxiety, and number of painful sites. A lower percent agreement was associated with poorer treatment outcomes. The percent agreement demonstrated a 41.2% capacity to predict residual pain after treatment. Conclusions: Clinicians can utilize percentage agreement as an adjunctive diagnostic tool to provide more suitable treatments to patients.

Impact of temporomandibular disorder symptoms among 15-year-old girls

OBJECTIVE

Many adolescents, especially girls, report temporomandibular disorder (TMD) symptoms that may impact their daily life.

METHODS

At 19 different schools participating in the preventive program with dental nurses of FRAMM (Fluoride, Advise, Arena, Motivation, Food), at the Västra Götaland Region in Sweden, 15-year-old girls were invited to a cohort study about symptoms of TMD that also included headaches. Three hundred twenty-nine girls attended the study and answered a questionnaire regarding TMD symptoms and their consequences such as sick leave from school and consumption of analgesics. The girls were asked about the symptom's influence on their daily life, about their general health, use of regular medication, physical activity, and they answered the PHQ4 regarding experienced symptoms of anxiety and depression.

RESULTS

There was a significant correlation between TMD symptoms and sick leave with 31% of the girls having stayed home due to symptoms. Of the girls who answered affirmative in the screening questions (3QTMD), nearly half the group had stayed at home due to their symptoms, 24% had consulted a physician, 42% had used analgesics weekly and 59% reported that they felt the symptoms negatively affected their school performance. The girls who had regular medication had more TMD symptoms. Anxiety and depression were associated with TMD symptoms.

CONCLUSION

The study showed that TMD symptoms had a negative impact on the 15-year-old girls' daily life resulting in sick leave from school, consumption of analgesics, and experiences of negative impacts on their behavior and performance at school.

Effects of different treatments for obstructive sleep apnea on temporomandibular joint: a randomized clinical trial

BACKGROUND

In recent years, obstructive sleep apnea (OSA) has been increasingly recognized as a significant health concern. No previous studies assessed the effect of recommended treatment modalities of patients with OSA on the temporomandibular joint (TMJ). The current study aimed to evaluate the effect of different treatment modalities of OSA, such as continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and oral myofunctional therapy (OMT) on subjective symptoms, clinical, and radiographic signs of temporomandibular disorders.

PATIENTS & METHODS

This hospital-based prospective randomized controlled clinical trial study was approved by the institutional review board and formal patient consent, 39 OSA patients, ranging in age from 19 to 56 after confirmation with full night Polysomnography (PSG) with healthy TMJ confirmed clinically and radiographically with magnetic resonance imaging (MRI) were randomly allocated into three treatment groups. Group 1: 13 patients were managed with CPAP after titration, group 2: 13 patients were managed with digitally fabricated MAD, and group 3: 13 patients were managed with OMT. The following parameters were evaluated before and 3 months after the intervention. Pain using a visual analogue scale (VAS), maximum inter-incisal opening (MIO), lateral movements, and clicking sound of TMJ. MRI was done before and 3 months after the intervention.

RESULTS

Out of the 83 patients enrolled, 39 patients completed the treatment. There were no statistically significant differences in lateral jaw movements or clicking, and no significant difference in MRI findings between the three studied groups before and after the intervention. The OMT group showed a statistically significant difference in pain (p = 0.001), and MIO (p = 0.043) where patients experienced mild pain and slight limitation in mouth opening after 3 months of follow-up in comparison to MAD and CPAP groups.

CONCLUSION

CPAP and MAD are better for preserving the health of TMJ in the treatment of OSA patients. While OMT showed mild pain and slight limitation of MIO (that is still within the normal range of mouth opening) compared to CPAP and MAD.

TRIAL REGISTRATION

The study was listed on www.

CLINICALTRIALS

gov with registration number (NCT05510882) on 22/08/2022.

Causal Relationship Between Obstructive Sleep Apnea and Temporomandibular Disorders: A Bidirectional Mendelian Randomization Analysis

Objective

This study was conducted to investigate the bidirectional causal relationship between obstructive sleep apnea (OSA) and temporomandibular disorders (TMD).

Methods

Using an online pooled dataset of genome-wide association studies (GWAS), a two-sample bi-directional Mendelian randomization (MR) method was implemented. Inverse variance weighting was used as the primary analyses approach, and other methods of MR Egger, weighted median method, MR-Egger, Simple mode, and Weighted mode analysis were conducted as supplements to evaluate the causal relationship between OSA and TMD with odds ratios (OR) and 95% confidence interval (CI). Furthermore, the Cochran Q, MR-Egger, and MR-PRESSO approaches were used to perform the heterogeneity test and multiple validity.

Results

The general results of the forward MR analysis indicated that OSA had a significant causal influence on TMD (OR=1.241, 95% CI: 1.009-1.526, P=0.041), but no significant correlation was observed in the reverse MR analysis (IVW: OR=0.975, 95% CI=0.918-1.036, P=0.411).

Conclusion

In summary, our research demonstrated a hereditary causative relationship between OSA and TMD, indicating that appropriate intervention is required for both prevention and treatment of TMD.

Causal effects of autoimmune diseases on temporomandibular disorders and the mediating pathways: a Mendelian randomization study

Background

The role of autoimmune diseases (ADs) in temporomandibular disorders (TMDs) has been emphasized in observational studies. However, whether the causation exists is unclear, and controversy remains about which specific disorder is destructive in TMDs. This Mendelian randomization (MR) study aims to estimate the causal effect of common ADs on TMDs.

Methods

Genetic data from published genome-wide association studies for fourteen common ADs, specifically multiple sclerosis (MS, N = 15,283), ankylosing spondylitis (AS, N = 22,647), asthma (N = 408,422), celiac disease (N = 15,283), Graves' disease (N = 458,620), Hashimoto thyroiditis (N = 395,640), primary biliary cirrhosis (PBC, N = 11,375), primary sclerosing cholangitis (PSC, N = 14,890), psoriasis vulgaris (N = 483,174), rheumatoid arthritis (RA, N = 417,256), systemic lupus erythematosus (SLE, N = 23,210), Type 1 diabetes (T1D, N = 520,580), inflammatory bowel disease (IBD, N = 34,652), and Sjogren's syndrome (SS, N = 407,746) were collected. Additionally, the latest summary-level data for TMDs (N = 228,812) were extracted from the FinnGen database. The overall effects of each immune traits were assessed via inverse-variance weighted (IVW), weighted median, and MR-Egger methods, and performed extensive sensitivity analyses. Finally, 731 immune cell phenotypes (N = 3,757) were analyzed for their mediating role in the significant causality.

Results

Univariable MR analyses revealed that genetically predicted RA (IVW OR: 1.12, 95% CI: 1.05-1.19, p < 0.001) and MS (IVW OR: 1.06, 95% CI: 1.03-1.10, p = 0.001) were associated with increased risk of TMDs. Two out of 731 immune cell phenotypes were identified as causal mediators in the associations of RA with TMDs, including "CD25++ CD8+ T cell % CD8+ T cell" (mediation proportion: 6.2%) and "CD3 on activated CD4 regulatory T cell" (5.4%). Additionally, "CD127 on granulocyte" mediated 10.6% of the total effect of MS on TMDs. No reverse directions, heterogeneity, and pleiotropy were detected in the analyses (p > 0.05).

Conclusion

This MR study provides new evidence regarding the causal impact of genetic predisposition to RA or MS on the increased risk of TMDs, potentially mediated by the modulation of immune cells. These findings highlight the importance for clinicians to pay more attention to patients with RA or MS when consulting for temporomandibular discomfort. The mediating role of specific immune cells is proposed but needs further investigation.

Investigating the effect of depression on clinical symptoms of temporomandibular disorder in young stressful men

OBJECTIVES

The objective of this study was to investigate the relationship of the depression level with temporomandibular disorders (TMDs) in young conscripts as a population with chronic stresses.

MATERIAL AND METHODS

A total number of 144 male conscripts with chronic stress and different levels of depression were assigned to four groups according to the Beck's Depression Inventory (BDI). The control group consisted of age-matched male conscripts without chronic stress. The diagnosis of TMD was made according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Data were analyzed using Mann-Whitney and chi-square tests.

RESULTS

The participants with severe depression were significantly more susceptible to have TMD (p = .001) followed by the moderate depression, borderline clinical depression, mild mood disturbance, and control groups. The TMD diagnoses were more prevalent within depression groups compared with the control population (p = .01).

CONCLUSIONS

The level of depression is directly associated with the presence of TMD in young men with chronic stress.

Anatomical factors influencing temporomandibular joint clicking in young adults: temporomandibular joint structure disorder or lateral pterygoid muscle dysfunction?

Objective: This study aimed to investigate the selected anatomical factors that can potentially influence temporomandibular joint (TMJ) clicking in young adults by assessing TMJ structures and lateral pterygoid muscle (LPM) function using magnetic resonance imaging (MRI). Methods: The patients were divided into four groups: the healthy control group; the clicking on mouth opening group; the clicking on mouth closing group; and the clicking on mouth opening and closing group. Additionally, we used clinical palpation to evaluate the masticatory muscles' functional state and employed MRI using the OCOR-T1WI-FSE-CLOSED, OSAG-PDW-FSE-CLOSED, and OSAG-PDW-FSE-OPEN sequences to analyze the texture of the lateral pterygoid muscle (LPM). Results: The proportion of any articular disc or condylar morphology class did not differ significantly between the TMJ clicking and HC groups. The articular disc position did not differ significantly between the TMJ clicking and HC groups. In the TMJ clicking group, the presence of masticatory muscle dysfunction differed significantly between the clicking and non-clicking sides. Moreover, the LPM accounted for the highest proportion among masticatory muscles with tenderness in all TMJ clicking subgroups (77.78%-100%). Therefore, in the TMJ clicking group, the LPM texture was less defined, more uniform in gray scale, and more similar to local texture (p < 0.0001). Conclusion: The occurrence of TMJ clicking in young adults is unrelated to the TMJ structure but related to the function of masticatory muscles, particularly the LPM.

Anxiety mediates association between sex and jaw function limitation in temporomandibular disorder patients from China

AIM

The objective of this study is to explore the relationship between sex and jaw function and to test whether anxiety mediates the causal relationship between sex and jaw function in temporomandibular disorders (TMDs) patients.

METHODS

A total of 488 participants with TMD were included in the analysis. Demographic data were collected. Generalized anxiety symptoms and anxiety severity were initially assessed using the GAD-7 questionnaire. And jaw function limitation was measured using the JFLS-8 scale. A directed acyclic graph (DAG) was used in this study to evaluate the hypotheses. Mediation analysis was conducted to explore causality and to calculate the total effect, natural direct effect (NDE) and natural indirect effect (NIE).

RESULTS

In TMD patients, there was a significant association between female and jaw function (r = 0.17, p < 0.001), female and anxiety (r = 0.15, p = 0.002), anxiety and jaw function (r = 0.35, p < 0.001). In addition, sex can directly lead to differences in impaired jaw function (NDE: 3.719, 95% CI: 1.619-5.828, p < 0.001), and can also be causally related to jaw function through anxiety (NIE: 1.146, 95% CI: 0.267-2.024, p = 0.011). And the total effect was 4.865 (95% CI, 2.709-7.029, p < 0.001).

CONCLUSION

A causal mechanism was found that anxiety acts as a mediator of sex effects on jaw function. Therefore, psychological factors need to be taken into account in the treatment of female TMD patients. Further clinical trials are needed to explore whether psychotherapy is more beneficial to improve jaw function in female TMD patients.

Depression in persons with disabilities: a scoping review

Individuals with disabilities are more vulnerable to depression development than the general population. This study sought to map the evidence on current knowledge of depression, intervention strategies, and assessment tools among people with disabilities. This review was conducted following Arksey and O'Malley's scoping review methodology framework. An electronic search was performed on four English databases: PubMed, Cochrane Library, PsycINFO, and Web of Science. The original search returned 1802 results, with 1,116 from Web of Science, 626 from PubMed, 25 from Cochrane, and 35 from PsycINFO. After removing duplicates, 786 articles were chosen for the title and abstract screening processes. Finally, 112 full-text publications were deemed eligible, with 41 papers being included in this scoping review for analysis. A large proportion (32; 78.04%) of the studies chosen were cross-sectional, 14 (34.14%) of them reported general disability, 12 (29.26%) used a patient health questionnaire (PHQ-9) to measure depression, and 14 (34.14%) had interventions, including cognitive behavioral therapy, psychological counseling, social support, and physical activity. All interventions successfully reduced the severity of the depression. Cognitive behavioral therapies and psychological counseling were widely used interventions that had a significant impact on reducing depression. More randomized controlled trials are required, and they should focus on individuals with specific disabilities to provide disability-specific care that can improve the quality of life for disabled individuals.

Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022

This study aims to conduct a systematic analysis of literature published between 1 January 2018 and 1 September 2022, exploring factors influencing the progression or development of temporomandibular disorders (TMD), diagnosed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three electronic databases were reviewed to identify papers that examined TMD factors using DC/TMD or RDC/TMD. Inclusion criteria encompassed original research published in English between 1 January 2018 and 1 October 2022, online, and complete DC/TMD or RDC/TMD studies on human participants aged 18 or older. Two authors independently assessed the risk of bias using The Joanna Briggs Institute (JBI) Analytical cross-sectional studies' Critical Appraisal Tool. Of 1478 articles, 11 were included. The studies revealed strong associations between TMD and factors such as female, poor sleep quality, depression, oral parafunction, anxiety, somatization, and anatomical features. However, variables such as education, living conditions, socioeconomic status, marital status, chronic pain, and stress did not exhibit statistically significant correlations. Based on the obtained data, it can be concluded that the causes of TMD are largely related to psychological factors, which supports the biopsychosocial theory of the disorder.

The Association Between Orofacial Pain and Depression: A Systematic Review

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Pregnancy related factors and temporomandibular disorders evaluated through the diagnostic criteria for temporomandibular disorders (DC/TMD) axis II: a cross sectional study

INTRODUCTION

Temporomandibular disorder (TMD) is a multifaceted condition impacting the chewing system, with its frequency varying across different age groups and showing a higher incidence in women. The involvement of estrogen in TMD has been examined due to the presence of estrogen receptors in the TMJ area. However, the exact effect of estrogen on TMD is complex. During pregnancy, marked by significant hormonal fluctuations, the impact on TMD has been hypothesized but remains unclear due to inconsistent results from various studies.

METHODS

In this cross-sectional study, we enrolled 32 pregnant women consecutively. We gathered information on demographics, TMD evaluations (using the Graded Chronic Pain Scale, Jaw Functional Limitation Scale-20, and Oral Behaviors Checklist), and mental health assessments (including Patient Health Questionnaire-9, Patient Health Questionnaire-15, and Generalized Anxiety Disorder-7). We employed descriptive statistics to summarize continuous and categorical data and used t-tests and chi-square tests for comparisons. We also conducted multivariate linear regression, adjusted for demographic factors, to investigate correlations.

RESULTS

The study group mainly consisted of women aged 30-35 (40.6%) and 25-30 (18.8%). Most participants had completed high school (50%) and were married (71.9%). A notable association was found between younger women (under 30) and higher levels of somatic symptoms (p = 0.008) and generalized anxiety (p = 0.015). Women in their second trimester showed lower severity of somatic symptoms (p = 0.04). A significant link was also observed between depression severity and somatic symptom severity (p = 0.01). However, we found no significant correlations with other TMD-related health aspects.

DISCUSSION

Our study identified significant associations between psychosomatic and psychological symptoms with variables like age and pregnancy trimester in pregnant women. However, it notably failed to establish a clear relationship between pregnancy-related factors and the severity of temporomandibular disorders (TMD). More comprehensive studies with larger participant pools are necessary to further validate and expand these findings.

Causal relationship between psychiatric traits and temporomandibular disorders: a bidirectional two-sample Mendelian randomization study

OBJECTIVES

This study was to investigate the causal relationship between temporomandibular disorders (TMD) and psychiatric disorders by Mendelian randomization (MR) analysis.

MATERIALS AND METHODS

A two-sample bidirectional MR analysis was adopted to systematically explore the causal relationship between TMD and eight psychiatric traits, including anxiety disorder (AD), panic disorder (PD), major depressive disorder (MDD), neuroticism, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BIP), and schizophrenia (SCZ). Inverse variance weighted (IVW), weighted median, and MR-Egger regression were used in my study. Furthermore, we also performed three sensitivity analyses to illustrate the reliability of the analysis.

RESULTS

Two psychiatric traits have risk effects on TMD: PD (OR = 1.118, 95% CI: 1.047-1.194, P = 8.161 × 10-4, MDD (OR = 1.961, 95% CI: 1.450-2.653, P = 1.230 × 10-5). Despite not surpassing the strict Bonferroni correction applied (P > 0.00625), we could think that there was a suggestive causal effect of neuroticism and SCZ increasing the risk of TMD. On the reverse MR analysis, we found no significant evidence of causal effects of TMD on these psychiatric traits. Except for heterogeneity in the causal analysis for SCZ on TMD, no heterogeneity and horizontal pleiotropy were detected in the other analyses.

CONCLUSIONS

Our two-sample MR study has provided further evidence of PD and MDD being related to a higher risk of TMD.

CLINICAL RELEVANCE

These findings highlight the importance of closely monitoring mental traits during future TMD treatments to prevent an increased risk of TMD.

Do myofascial trigger points in masseter muscles affect the symptoms of disc displacement with reduction? A cross-sectional study

OBJECTIVE

The aim of this study was to demonstrate the effect of myofascial pain with referral from the trigger points in the masseter muscles on the clinical symptoms and functional limitations of the temporomandibular joint in participants with disc displacement with reduction.

METHODS

This prospective, cross-sectional study recruited participants aged 18-45 years with disc displacement with reduction with/without myofascial pain with referral in the masseter muscles based on the inclusion criteria. Maximum mouth opening and the presence of probable awake bruxism were assessed. The "Graded Chronic Pain Scale version 2.0" and "Jaw Function Limitation Scale-8" were used to evaluate Diagnostic Criteria for Temporomandibular Disorders Axis II. Pain levels were measured using the Visual Analog Scale.

RESULTS

A comparison between the disc displacement with reduction and disc displacement with reduction+myofascial pain with referral groups revealed statistically significant differences in Visual Analog Scale (p<0.001), the presence of awake bruxism (p=0.038), and Graded Chronic Pain Scale version 2.0 (p=0.010). However, no statistically significant difference was observed between the two groups concerning maximum mouth opening and Jaw Function Limitation Scale-8.

CONCLUSION

Participants with both disc displacement with reduction and myofascial pain with referral in the masseter muscle exhibited higher pain intensity, a higher prevalence of awake bruxism, and increased pain-related disability compared to those with disc displacement with reduction alone.

Malocclusion Complexity in Patients with Disc Displacement Disorders: A Case-Control Study

This study aimed to determine the possible association between disc displacement (DD) disorders and malocclusion complexity. This cross-sectional study was carried out using a case-control design. The Research Diagnosis Criteria for Temporomandibular Disorders were used to identify cases and controls. The Index of Complexity, Outcome, and Need (ICON) was used to quantify malocclusion complexity as easy, mild, moderate, difficult, or very difficult. A total of 310 subjects were included: 130 cases and 180 controls. A binary logistic regression (p < 0.05) was used to identify associations. The odds ratio (OR) was also calculated. DD was associated with sex, age, and malocclusion complexity (p < 0.05). The malocclusion complexity comparison showed that 89.3% of the controls fell within the easy-moderate levels of the ICON, whereas 85.4% of the cases were in the moderate-very difficult levels (p ≤ 0.001). Difficult and very difficult malocclusions had high ORs (9.801 and 9.689, respectively) compared to the easy cases. In conclusion, patients with malocclusion complexity levels classified as difficult or very difficult have greater odds of presenting DD.

Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age

According to the current international consensus [...].