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Wan J, Lin J, Zha T, Ciruela F, Jiang S, Wu Z, Fang X, Chen Q, Chen X. Temporomandibular disorders and mental health: shared etiologies and treatment approaches. J Headache Pain 2025; 26:52. [PMID: 40075300 PMCID: PMC11899861 DOI: 10.1186/s10194-025-01985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
The biopsychosocial model suggests that temporomandibular disorders (TMDs) often coexist with mental health disorders, particularly depression and anxiety, affecting a significant portion of the global population. The interplay between TMDs and mental health disorders contributes to a complex comorbidity, perpetuating a cycle of mutual influence and reinforcement. This review investigates the neurobiological mechanisms and epidemiological evidence supporting the shared etiology of TMDs and mental health disorders, exploring potential shared vulnerabilities and bidirectional causal relationships. Shared vulnerabilities between TMDs and mental health disorders may stem from genetic and epigenetic predispositions, psychosocial factors, and behavioral aspects. Inflammatory cytokines, neurotransmitters, neurotrophins, and neuropeptides play pivotal roles in both peripheral and central sensitization as well as neuroinflammation. Brain imaging studies suggest that TMDs and mental health disorders exhibit overlapping brain regions indicative of reward processing deficits and anomalies within the triple network model. Future research efforts are crucial for developing a comprehensive understanding of the underlying mechanisms and confirming the reciprocal causal effects between TMDs and mental health disorders. This review provides valuable insights for oral healthcare professionals, stressing the importance of optimizing treatment strategies for individuals dealing with concurrent TMDs and mental health issues through a personalized, holistic, and multidisciplinary approach.
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Affiliation(s)
- Jiamin Wan
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiu Lin
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Tingfeng Zha
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Francisco Ciruela
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, IDIBELL-Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Shaokang Jiang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Zuping Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Xinyi Fang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
| | - Xiaoyan Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
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Vallin S, Liv P, Häggman-Henrikson B, Visscher CM, Lobbezoo F, Lövgren A. Temporomandibular disorder pain is associated with increased sick leave and reduced health related quality of life. Eur J Pain 2024; 28:1827-1840. [PMID: 39072933 DOI: 10.1002/ejp.2314] [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: 04/24/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are the most common reason for chronic pain in the orofacial area and significantly impact the lives of those affected. The role of lifestyle factors in TMD, however, remains less explored. This cohort study aims to estimate TMD prevalence by addressing potential selection biases and to evaluate the association between TMD and lifestyle factors with a specific focus on sick leave and health related quality of life. METHODS By linking data on TMD in the general population in Västerbotten, northern Sweden (n = 180,000) to health survey data (n = 120,000), information on sociodemographic factors and quality of life was available for 52,961 individuals (50.6% women) with a mean age of 53 years. We applied inverse probability weighting to adjust for selection bias and Poisson regression to explore associations with TMD. RESULTS TMD prevalence was 9.2% during the study period, being higher in women (12.9%) than men (5.4%). Weighting for varying visiting frequencies did not affect TMD prevalence (average difference 0.4% points). Individuals with TMD, especially women, reported more sick leave and use of pain medication, with a significant association between TMD and increased sick leave (prevalence ratio 1.89, 95% CI: 1.78-2.01) among both women and men. In addition, TMD was associated with a lower health related quality of life (p < 0.001). CONCLUSION The association of TMD with sick leave highlights the condition's profound impact on the lives of affected individuals. These findings underscore the influence of TMD on work life and the burden of TMD on the societal level. SIGNIFICANCE STATEMENT The findings provide insight into how TMD affect individuals, by incorporating lifestyle factors, social determinants and the impact of sick leave at a population level. By incorporating these areas into the study of TMD, we can deepen our understanding of how TMD affects individuals' lives. This approach may also create opportunities to develop more comprehensive strategies to address TMD, focusing on broader implications beyond the clinical symptoms.
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Affiliation(s)
- S Vallin
- Department of Odontology, Orofacial Pain and Jaw Function, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - P Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - B Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - C M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Lövgren
- Department of Odontology, Orofacial Pain and Jaw Function, Faculty of Medicine, Umeå University, Umeå, Sweden
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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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