Psychological Factors and Temporomandibular Outcomes

This study examines the effect of psychological dysfunction as an etiological factor in temporomandibular disorder (TMD). It employs a thoroughly validated psychometric measurement system, the TMJ Scale (Pain Resource Center, Inc., Durham, North Carolina), to determine the effects of pretreatment stress and psychological dysfunction upon presenting symptom levels. The study also addresses these parameters for the eventual treatment outcome. During the course of this study, 2,074 patients were evaluated. Seven hundred and fifty-four by Dr. Steed and 1,320 by Dr. Wexler. Both practices address essentially identical patient populations and focus special interest in craniofacial pain and the diagnosis and Phase I treatment of temporomandibular dysfunction. Of the patients in the study who were found to have clinically treatable temporomandibular disorders, 561 consecutive patients completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The TMJ Scale was re-administered to this post-treatment population. This study summarized findings pertinent to the four primary issues: 1. pre-treatment psychological factors and stress, which seem to be moderately related to presenting pain levels and overall TMD levels (excepting joint function); 2. treatment outcomes which appeared to be unrelated to the initial psychosocial symptom severity; 3. physical symptoms outcomes and psychosocial outcomes which appeared to be significantly related and; 4. intracapsular symptom improvement which appeared to be unrelated to psychological functioning changes but mildly related to stress.     

Trauma in patients with temporomandibular disorders: frequency and treatment outcome

summary Controversy exists on the aetiological importance and the effect of jaw macrotrauma (fractures excluded) on the occurrence of temporomandibular joint disorders (TMD). The purpose of this study was to assess the incidence of jaw injury in TMD patients and to compare the severity of the symptoms, the clinical characteristics and the treatment outcome in TMD patients with or without a history of trauma to the head and neck region directly linked to the onset of symptoms. The study sample included 400 consecutive TMD clinical patients. In 24.5% of patients the onset of the pain and dysfunction could be linked directly to the trauma, mainly whiplash accidents. No significant differences could be found between the two groups in daily recurrent headache, dizziness, neck pain, joint crepitation and pain in the joints. Maximal mouth opening was less than 20 mm in 14.3% of patients with a history of trauma and in 4.1% of those without such a history. According to the Helkimo dysfunction index (DI), more trauma than non-trauma TMD patients belonged to the severe dysfunction groups (DI 4 and 5) at first examination. The outcome of a conservative treatment procedure (counselling, occlusal splint, physiotherapy, occasionally occlusal therapy and non-steroidal anti-inflammation drugs was not different between the two groups at the 1 year evaluation. The degree of maximal opening was similar: less than 20 mm in 3.7% and 2.2% in trauma and non-trauma patients respectively. Forty percent and 41% respectively were symptom free or had DI = 1. The results suggest that external trauma to the joint or to the jaw in general is an important initiating factor in the aetiology of TMD but also that the prognosis is favourable.     

Comparison of clinical findings and psychosocial factors in patients with atypical odontalgia and temporomandibular disorders

AIMS: To systematically compare clinical findings and psychosocial factors between patients suffering from atypical odontalgia (AO) and an age- and gender-matched group of patients with temporomandibular disorders (TMD). METHODS: Forty-six AO patients (7 men and 39 women; mean age, 56 years) were compared with 41 TMD patients (8 men and 33 women; mean age, 58 years). RESULTS: Mean pain intensity at the time of inclusion in the study was similar between the groups (TMD: 5.3 +/- 0.4, AO: 5.0 +/- 0.3), but pain duration was longer in AO patients (AO: 7.7 +/- 1.1 years, TMD: 4.5 +/- 0.1 years). Eighty-three percent of the AO patients and 15% of TMD patients reported pain onset in relation to dental/surgical procedures. Episodic tension-type headache (TTH) occurred equally in both groups (TMD: 46%, AO: 46%), but TMD patients more frequently experienced chronic TTH (TMD: 35%, AO: 18%), myofascial TMD (TMD: 93%, AO: 50%), and temporomandibular joint disorders (TMD: 66%, AO: 2%). Overall, TMD patients had lower pressure pain thresholds and poorer jaw function than AO patients. Mean depression and somatization scores were moderate to severe in both groups, and widespread pain was most common in TMD patients. CONCLUSION: AO and TMD share some characteristics but differ significantly in report of dental trauma, jaw function, pain duration, and pain site.     

Clinical and psychological characteristics of TMD patients with trauma history

Oral Diseases (2010) 16 , 188–192 Objective: The purpose of this study was to investigate clinical and psychological characteristics of temporomandibular disorders (TMD) patients with trauma history. Materials and methods: The clinical and psychological characteristics of 34 TMD patients with trauma history were compared with those of 340 TMD patients without trauma history. Craniomandibular index (CMI) was used for clinical characteristics of TMD patients. Symptom severity index (SSI) was used to assess the multiple dimensions of pain. Symptom checklist‐90‐revision (SCL‐90‐R) was used for psychological evaluation. Results: Temporomandibular disorders patients with trauma history displayed significantly higher CMI and palpation index. TMD patients with trauma history also exhibited higher values in duration, sensory intensity, affective intensity, tolerability, scope of symptom, and total SSI score. In addition, these patients showed significantly higher values in symptom dimensions of somatization, depression, anxiety, phobic anxiety, and paranoid ideation. Among the symptom dimensions of SCL‐90‐R, somatization showed the most significant correlations with CMI and SSI. Conclusions: Temporomandibular disorders patients with trauma history displayed more severe subjective, objective, and psychological dysfunction than those without trauma history. Pain of myogenous origin, history of physical trauma, and psychosocial dysfunction were all closely related.     

Prevalence of whiplash trauma in TMD patients: a systematic review

The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 8·4% to 70% (median 35%) in TMD populations, compared with 1·7–13% in the non‐TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non‐TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head–neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.     

Prevalence of temporomandibular disorder pain,jaw noises and oral behaviours in an adult Italian population sample

To evaluate the prevalence of temporomandibular disorder pain (TMD‐pain), temporomandibular joint (TMJ) noises, oral behaviours in an Italian adult population sample, their possible association with gender, oral behaviours, self‐reported facial trauma and orthodontic treatment. Subjects older than 18 years were recruited from general population in public spaces during their daily life. A specific questionnaire was developed to collect data on TMD‐pain, TMJ noises, oral behaviours, orthodontic treatment and facial trauma. A total of 4299 subjects were included in the study. The most common symptom in the sample was TMJ clicking (30.7%), followed by TMD‐pain (16.3%) and TMJ crepitus (10.3%). Oral behaviours were reported in 29% of the sample; 43.6% of the sample reported a previous or ongoing orthodontic treatment. TMD‐pain and TMJ clicking were significantly associated to gender, oral behaviours and a positive history of previous facial trauma. Crepitus was significantly associated to oral behaviours, facial trauma and higher age. Ongoing orthodontic treatment was significantly associated to TMD‐pain and TMJ sounds. In a general Italian adult population sample, TMD‐pain is associated to female gender and is less prevalent than TMJ clicking. TMDs are associated to trauma and oral behaviours.     

TMD Treatment Outcomes: A Statistical Assessment of the Effects of Psychological Variables

This study analyzes the degree to which pretreatment psychosocial factors (psychological dysfunctions and stress)effect outcome in 269 consecutive temporomandibular disorder (TMD) patients at the completion of treatment. Employing the TMJ Scale, a validated measure of TMD symptoms, it is found that pretreatment TMD pain and overall symptom levels (excluding internal derangement symptoms) are weakly but nevertheless, significantly related to pretreatment psychological dysfunction and stress. However, the latter appeared totally unrelated to four treatment outcome measures. Additionally, the data supports the hypothesis that both initial and post-treatment intrascapular symptoms (TMJ Scale, Joint Dysfunction sub-scale) are unrelated to psychosocial factors. Data from this study call into question the value of categorizing the TMD patients by means of psychosocial “profiling” and “dual-axis” classification methods proposed by some researchers.     

应用RDC／TMD评估我国颞下颌关节紊乱病患者轴Ⅱ诊断的研究

目的应用颞下颌关节紊乱病研究诊断标准（RDC／TMI））中文版评估我国颞下颌关节紊乱病（TMD）患者的轴Ⅱ诊断。方法选择2011年6-11月在中山大学附属口腔医院就诊的142例TMD患者,使用RDC／TMD中文版对其进行调查,分析这些患者轴Ⅱ诊断。结果共收回有效量表133份,量表的完成率为93．7％,其中男38例,女95例,男女比例1：2．5。患者年龄高发于18～44岁。67．7％的患者接受过大学文化教育,84．2％的患者月收入在5000元以下。32.3％的患者存在中到重度抑郁症状;31．6％的患者存在非特异性生理症状（包含疼痛）;33．8％的患者存在非特异性生理症状（除外疼痛）;TMD主要影响颌骨的咀嚼、吃硬食物和打呵欠等功能;不同人口统计学条件下的抑郁、非特异性生理症状得分差异无统计学意义（P〉0．05）;抑郁症状与非特异性生理症状相关性分析显示,二者呈正相关（P〈0．05）。结论TMD患者存在不同程度抑郁症状和非特异性生理症状;TMD主要影响颌骨的咀嚼、吃硬食物和打呵欠等功能;TMD患者的抑郁症状与非特异性生理症状呈正相关关系。     

History factors associated with symptoms of temporomandibular disorders

Differences in prevalence of head or neck trauma, orthodontic treatment and molar oral surgery procedures reported by individuals were compared among patients with temporomandibular disorders (TMD) and with two comparison groups (a sample of asymptomatic individuals, and a sample with mild or early signs). Association to specific TMD symptoms was tested amongst the comparison groups. Trauma was the most significant factor characterizing TMD patients. History of trauma was also more common among those otherwise normal but symptomatic individuals in the non-patient comparison group. Specific TMD symptoms were significantly associated with history of trauma in the comparison group. Significantly more women TMD patients had a history of orthodontic and molar oral surgery treatment than the asymptomatic comparison group. History of orthodontics was also associated with the symptomatic sample of the comparison group in women, but it was not significantly related to any specific TMD symptoms. Symptomatic members of the comparison group could not be differentiated based upon history of molar oral surgery. Certain risk factors may have been delineated, but causal relationship of treatment requires study of co-existing and predisposing behavioural and structural factors.     

咬合干扰与颞下颌关节紊乱病的相关性研究

目的:通过临床检查分析安氏Ⅱ类1分类颞下颌关节紊乱(temporomandibular disorders,TMD)患者的咬合特点,探讨咬合干扰与颞下颌关节紊乱的相关性。方法:选取安氏Ⅱ类1分类TMD患者60例为实验组,无TMD安氏Ⅱ类1分类患者60例为对照组。采用目前国际上通用的视觉模拟尺分级评分测量法(visual analog scale VAS)对口面部不舒适程度进行评价;按照Fricton指数所包括的内容计算颞下颌功能障碍指数(temporomandibular dysfunction index DI),[DI=(MM+JN+JP)/26(0~1)],该指数包括下颌运动(MM)、关节杂音(JN)及关节压诊(JP)等。结果:实验组有咬合干扰者45例,对照组有咬合干扰者42例,二组间差异无显著性(P>0.05);实验组中存在咬合干扰的患者与无咬合干扰患者相比较,DI指数以及疼痛相关视觉模拟分数(VAS)均偏高,二者间差异有统计学意义(P<0.01),其中女性患者DI指数高于男性。结论:咬合干扰(occlusal interferences,OI)与TMD虽无直接联系,但OI与TMD共存可加重TMD患者临床症状,OI的存在对口颌系统的健康可能构成威胁。     

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??Abstract?? Objective To assess the axis ?? diagnosis of TMD patients in China who seek treatment for TMD using Research Diagnostic Criteria for TMD ??RDC/TMD??. Methods Clinical data of the TMD patients were collected using the RDC/TMD. Results A total of 142 TMD patients were surveyed and examined clinically. There were 133 valid scales involving 9 with missing data??There were 38 men and 95 women with the ratio of 1??2.5. Patients suffered from TMD were commonly seen at the age between 18 and 44?? and 67.7% of TMD patients received college education?? the income of 84.2% TMD patients were below 5000yuan. The axis diagnosis indicated that there were psychological distress and psychosocial dysfunction in TMD patients with no statistical significance among different demography situation ??P > 0.05??. The TMD patients’ depressive symptoms were clearly associated with widespread non-speci?c physical symptoms even when pain items were excluded from the calculation to reduce the effects of pain co-morbidity ??P < 0.05??.Conclusion There are psychological distress and psychosocial dysfunction in TMD patients. The TMD patients’ depressive symptoms are clearly associated with widespread non-speci?c physical symptoms even when pain items are excluded from the calculation to reduce the effects of pain co-morbidity.     

Functional and psychosocial impact related to specific temporomandibular disorder diagnoses

OBJECTIVES: Comparing the level of impaired oral health-related quality of life (OHRQoL) in patients with a specific temporomandibular disorder (TMD) diagnosis to general population subjects unaffected by TMD to derive the unique functional and psychosocial impact due to TMD. METHODS: A sample of 471 consecutive treatment seeking adult patients with at least one physical (axis I) TMD diagnosis according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD) was included in this study. OHRQoL was measured using the oral health impact profile (OHIP). To derive functional and psychosocial impact due to TMD mean OHIP scores were calculated from adult subjects of a regional population sample without any RDC/TMD axis I diagnosis (N=135) from which a subgroup without any sign/symptom according to the Helkimo-index (N=35) was derived. These means were subtracted from mean OHIP scores of the TMD patients. RESULTS: All TMD patients with a single axis I diagnosis presented much higher impaired OHRQoL (OHIP means: 27.5-56.2) compared to general population subjects (9.7 in subjects without any TMD sign/symptom and 14.8 in those without RDC/TMD axis I diagnosis). Group I diagnosis (myofascial pain) showed the highest OHRQoL impact with the lowest in patients with group II diagnosis (disc displacement). Patients with two pain-related diagnoses had significantly higher impaired OHRQoL than patients with a single one (58.9 versus 49.2, p=0.03). CONCLUSIONS: All TMD axis I diagnoses have significant impact on OHRQoL. Subjects with pain-associated conditions present higher scores than those without pain. Patients with two pain-related diagnoses have more impaired OHRQoL than subjects with one diagnosis.     

Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents

AIMS: To assess the prevalence of temporomandibular disorder (TMD) pain in Swedish adolescents, to evaluate whether there are differences in TMD pain in regard to age, gender, and place of residence (urban or rural), and to evaluate treatment for TMD pain and compare it with documented treatment for teeth with caries. METHODS: All youths aged 12 to 19 years in Osterg?tland County were eligible to participate in the investigation, which took place at public dental clinics during annual examinations in 2000. The subjects were asked 2 questions: (1) "Do you have pain in your temples, face, jaw joint, or jaws once a week or more?" and (2) "Do you have pain when you open your mouth wide or chew once a week or more?" Two hundred dental records of patients with TMD pain and 100 records of patients with documented caries were randomly selected from the population. These records were used to compare the treatment of TMD pain to the treatment of caries. RESULTS: Among the 28,899 youths participating, 4.2% reported TMD pain. The prevalence increased with age, and a significant difference was seen between boys (2.7%) and girls (6.0%) (P < .001). In 43% of the patients with TMD pain, the TMD condition was noted in the record. TMD-related treatment was given to 34% of patients with TMD pain in dental clinics, whereas 100% of the patients with caries received restorative treatment. The most common treatment modalities for the TMD group were occlusal splints and information about TMD. CONCLUSION: The prevalence of self-reported TMD pain was relatively low, increased with age, and was higher among girls than boys. One third of the patients with TMD pain received some form of TMD treatment in the dental clinics.     

Role of temporomandibular disorders (TMD) in facial pain: occlusion, muscle and TMJ pain

Temporomandibular disorders (TMD) which comprise myogenic and arthralgic components have been reported to predispose subjects to headache and facial pain. The aim of this study was to evaluate the role of these components in patients with facial pain and to investigate the influence of treatment of TMD on pain of these patients. The subject group consisted of 25 patients suffering from facial pain. The clinical stomatognathic examination was performed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the anamnestic (AI) and clinical dysfunction (DI) indices of Helkimo. The intensity of pain was evaluated on a numerical rating scale (NRS). According to clinical findings the patients were classified to following diagnostic subgroups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD comb (both myogenic and arthrogenous components involved). Fifteen patients were classified in the TMD myo group, nine in the TMD comb group and one in the TMD arthro group. The DI index decreased significantly one-two weeks after treatment and remained at this level at three month and one year follow-up examinations. At the first examination the TMD myo group had the highest level of NRS index, which decreased significantly during the time of follow-up, while no significant changes were found in other groups. Bruxism reported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that facial pain combined with TMD may be mostly of myogenic origin, and myogenic pain seems to have most favorable response to conservative treatment of TMD.     

Role of Temporomandibular Disorders (TMD) in Facial Pain: Occlusion,Muscle and TMJ Pain

Temporomandibular disorders (TMD) which comprise myogenic and arthralgic components have been reported to predispose subjects to headache and facial pain. The aim of this study was to evaluate the role of these components in patients with facial pain and to investigate the influence of treatment of TMD on pain of these patients. The subject group consisted of 25 patients suffering from facial pain. The clinical stomatognathic examination was performed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the anamnestic (AI) and clinical dysfunction (DI) indices of Helkimo. The intensity of pain was evaluated on a numerical rating scale (NRS). According to clinical findings the patients were classified to following diagnostic subgroups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD comb (both myogenic and arthrogenous components involved). Fifteen patients were classified in the TMD myo group, nine in the TMD comb group and one in the TMD arthro group. The DI index decreased significantly one-two weeks after treatment and remained at this level at three month and one year follow-up examinations. At the first examination the TMD myo group had the highest level of NRS index, which decreased significantly during the time of follow-up, while no significant changes were found in other groups. Bruxism reported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that facial pain combined with TMD may be mostly of myogenic origin, and myogenic pain seems to have most favorable response to conservative treatment of TMD.     

Reliability, validity, incidence and impact of temporormandibular pain disorders in adolescents

The first aim of this thesis was to investigate the prevalence of temporomandibular disorder (TMD) pain in adolescents an a Swedish county and whether there were differences in patient age and gender and in treatment given for TMD pain by dentists in Public Dental Service (PDS) clinics. The epidemiological variable TMD-S was introduced in the PDS in Osterg?tland County, Sweden, in 2000 and is recorded for all adolescents aged 12-19 at the annual routine examination. Self-reported TMD pain in this investigation was based upon the response of the subjects to two questions: (1) Do you have pain in your temples, face, temporomandibular joint, or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew, once a week or more? Dental records of 200 patients with TMD pain were randomly selected from the population to evaluate treatment given for TMD. Among 28,899 participating adolescents, 4.2% reported TMD pain. Prevalence increased with age, a significant difference was seen between boys and girls, and 34% of patients with TMD pain received TMD-relared treatment in dental clinics. The second aim was to evaluate the reliability and validity of self-reported TMD pain in 120 adolescents, 60 with self-reported TMD pain and 60 age- and sex-matched controls without TMD pain. All adolescents were examined twice at a PDS clinic. At the first examination, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was made blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Test-retest reliability of 0.83 (kappa) was found for the two questions. Sensitivity was 0.98 and specificity 0.90 for assessments made on the same day and 0.96 and 0.83, respectively, for assessments made 2-4 weeks apart. The third aim was to evaluate incidence, by age and gender, and temporal patterns of TMD pain in adolescents. This 3-year longitudinal study was carried out at all PDS clinics from 2000 to 2003. All individuals aged 12-19 years in the county who visited the clinics for annual examinations were eligible for the study. Overall, the annual incidence of TMD pain among 2255 participating adolescents was 2.9%. Incidence among girls (4.5% was significantly higher than in boys (1.3%). Incidence increased with age in girls and boys, although less so in boys. These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. The fourth and final aim was to investigate gender and age differences in pain behavior, jaw function, and psychosocial status in adolescents with self-reported TMD pain. A postal questionnaire was sent to 350 consecutive patients with self-reported TMD pain and 350 healthy age- and sex-matched individuals aged 12-19 years 2-4 weeks after their annual dental examination. The groups were divided into younger (age 12-15) and older (age 16-19) groups. The TMD and control groups differed significantly in most variables related to pain characteristics and psychosocial and behavioral factors. Multiple pain sites were significantly more common in the TMD than in the control group, but there were no gender differences. For adolescents reporting pain once a week or more, no gender differences were seen in pain intensities. Jaw function limitation, depression scores, and perceived need for TMD treatment were significantly higher overall in girls than in boys. Almost one-third of older girls, compared to one out of ten older boys, reported school absences and analgesic consumption because of their TMD pain. Older girls had significantly higher Graded Chronic Pain Scale scores than older boys. In conclusion, TMD pain increases with increasing age in adolescents and is more common in girls than in boys. A fluctuating pain pattern can be seen. TMD-S, with two self-report questions, has very good reliability and validity, and can be recommended for screening adolescents for TMD pain. TMD pain seems to have a greater Impact on girls than boys. particularly in ages 16-19 years.     

Temporomandibular disorders in adolescents. Epidemiological and methodological studies and a randomized controlled trial

The aim of the present thesis was to investigate different aspects of temporomandibular disorders (TMD) and pain such as prevalence, diagnostics, and treatment among adolescents. The reliability of a questionnaire and the clinical examination and diagnoses according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were assessed. Overall, we found it possible to assess and diagnose TMD in adolescents in a reliable way. The prevalence of TMD pain, gender differences, and the need for treatment were investigated among 864 adolescents from a Public Dental Service clinic. Seven percent of the subjects received a pain diagnosis according to the RDC/TMD, and the prevalence was higher among girls than boys. More subjects with TMD pain reported school absence and analgesic consumption compared to controls. Approximately every second subject who reported TMD pain also perceived a need for treatment. In an evaluation of psychosocial and dental factors, the following were found to play an important role in adolescents with TMD: stress, somatic complaints, and emotional problems. Three treatment methods were compared in a randomized controlled trial: brief information only, brief information and occlusal appliance, and brief information and relaxation therapy. In the brief information and occlusal appliance group, 60%--significantly more than in the other two groups--experienced a reduction of at least 50% in TMD pain. The influence of somatic and emotional stimuli was evaluated, and we found that adolescents with TMD pain were significantly more sensitive to not only aversive somatic but also pleasant somatic stimuli compared with healthy controls. The results suggest that not only nociceptive but also cognitive processes are implicated in chronic pain states in young TMD subjects. In conclusion, TMD pain is more common in girls than in boys and affects daily life. TMD pain in adolescents can best be improved by traditional treatment with occlusal appliance combined with brief information.     

Multiple pains and psychosocial functioning/psychologic distress in TMD patients

PURPOSE: This study assessed multiple pain conditions and their association with psychosocial functioning, psychologic distress, and somatization in patients with temporomandibular disorders (TMD) based on RDC/TMD Axis II findings. Nonspecific pain items examined included headaches, heart/chest pain, lower back pain, nausea/abdominal pain, and muscle pain. MATERIALS AND METHODS: In this study, 202 TMD patients (58 men and 144 women) referred to two TMD clinics participated. The mean age of the predominantly Chinese patient population (82%) was 32.6 years (range 13 to 65). The RDC/TMD history questionnaire was input directly into computers by patients. Graded chronic pain and SCL-90 scales were generated online and automatically archived for statistical analysis. Data were subjected to Spearman's rank-order correlation and Kruskal-Wallis and Mann-Whitney tests at a significance level of .05. RESULTS: Of the patients, 43% were moderately to extremely distressed by headaches. The percentage of patients who were distressed by heart/chest pain (7%), lower back pain (26%), nausea/abdominal pain (17%) and soreness of muscles (22%) was lower. Of the TMD patients, 16% experienced more than three pain items. Significant and positive correlations were observed between number of pain items experienced and graded chronic pain severity, depression, and somatization. Correlation coefficients ranged from .27 to .65 for graded chronic pain scales and somatization (without pain items) scores, respectively. CONCLUSION: Results suggest that the number of nonspecific pain conditions reported may be a predictor of psychosocial dysfunction, depression, and somatization.     

Temporomandibular joint and psychosocial evaluation of patients after orthognathic surgery: A preliminary study

PurposeThe purpose of this study was to evaluate the psychological and psychosocial status of patients prior to and after orthognathic surgery.Materials and methodsTwenty-two patients (13 males and 9 females) who underwent orthognathic surgery were examined in this study. The bilateral sagittal split ramus osteotomy (BSSRO) group included 10 patients, and the Le Fort I osteotomy and BSSRO group included 12 patients. We continued RDC/TMD Axis II research for 12 patients who had preoperative temporomandibular joint disorder (TMD). The RDC/TMD Axis II charts were recorded preoperatively and 6 months after surgery. The Wilcoxon signed rank test was used for statistical analysis.ResultsOverall, there was no significant difference between the preoperative and 6-month postoperative depression indices. The non-specific physical symptoms score (NPS) with pain score decreased significantly (p < 0.05), but the NPS without pain score decreased insignificantly. In terms of the graded pain score for the preoperative group, 75.0% of the patients were in the low disability group, whereas 25.0% were in the high disability group. In contrast, patients in the postoperative group only fell into the low disability group (p < 0.05).ConclusionThe RDC/TMD Axis II was developed to diagnose TMD, but we believe the RDC/TMD Axis II can help to establish postoperative treatment plans by evaluating a patient's psychological and psychosocial state.     

Symptoms of the stomatognathic system in temporomandibular and cervical spine disorders

This study was performed to assess the prevalance of signs and symptoms of temporomandibular disorders (TMD) in patients with cervical spine disorders (CSD) and to compare patients with CSD and subgroups of patients with TMD with regard to the results of orthopaedic tests of the stomatognathic system. A group of 103 consecutive patients with signs and symptoms of CSD and a group of 111 consecutive patients with TMD were examined. All subgroups of TMD patients showed a significantly smaller range of motion than the CSD patients. Patients with TMD had limited mouth opening (<40 mm) on active and passive mouth opening more often than CSD patients. TMD patients with myogenous problems reported oral habits more often than CSD patients, although no objective differences between CSD and TMD patients were found. Subgroups of TMD patients reported joint sounds, and pain on palpation and joint play tests of the temporomandibular joint (TMJ) more frequently than CSD patients. Joint sounds on active movements, pain on palpation of the TMJ, and pain on joint play tests correctly classified 82% of the patients with TMD and 72% of the patients with CSD. In spite of the biomechanical and anatomical relationship between the neck and the stomatognathic system, the results of the study show that CSD patients have signs and symptoms of TMD comparable with those of the adult Dutch population. It was concluded that the function of the masticatory system should be evaluated in patients with neck complaints in order to rule out a possible involvement of the masticatory system.