Psychosocial profiles of diagnostic subgroups of temporomandibular disorder patients

The purpose of the study was to examine whether patients' psychosocial profiles differ depending on if the location of pain is in the masticatory muscles, the temporomandibular joint, or both. Eligible participants were 491 consecutive patients examined according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Among these a total of 225 adult TMD patients had at least one pain-related TMD diagnosis and were therefore included in this study and completed the multidimensional pain inventory (MPI). Patients diagnosed with myogenous pain only ( n  = 103), patients with joint pain only ( n  = 56), and patients with both ( n  = 66) were compared with respect to depression, somatization, jaw disability, pain intensity and chronicity, and MPI scores and profiles. The MPI profiles were analyzed using a multivariate analysis of variance and Hotelling's T² test. Although patients with joint pain were significantly more impaired in jaw function, no significant differences in depression, in somatization or in the 11 scales of the MPI were observed. The location of pain in TMD patients is not a major factor for the prediction of psychosocial profiles. Therefore, clinical TMD diagnoses alone form an insufficient basis for tailored behavioural or psychological management.     

Diagnosis and classification of temporomandibular dysfunction by the general dental practitioner

Because of other diseases mimicking the symptoms of temporomandibular dysfunction (TMD), differential diagnosis is of the utmost importance. Diagnostic subgroups of TMD (osteoarthrosis, anterior disc displacement with/without reduction, TMD-myo) can be distinguished by a combination of active movements, passive opening and palpation. Active movement appeared to be the most powerful test for distinguishing the subgroups of TMD, e.g. myogenous, arthrogenous, myogenous and arthrogenous. It is advised to have an open mind in the clinical examination and to be aware of the many mimicking disorders before reaching a diagnosis. An anamnestic questionnaire addressing the pain history, signs and symptoms of TMD, functional impairments, correlates of TMD, psychosocial evaluation and general health status is mandatory. Headache and neck pain often accompany TMD. In appropriate situations it is advised to refer to the proper specialist, before starting treatment for TMD. Orthopedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with cervical spine disorders (CSD). It is therefore advised to evaluate the function of the stomatognathic system in patients with neck complaints to rule out a possible involvement of this system.     

Oral health-related quality of life in patients with temporomandibular disorders

AIMS: To characterize the level of impairment of oral health-related quality of life (OHRQoL) in a temporomandibular disorder (TMD) patient population. METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G) in a consecutive sample of 416 patients seeking treatment for their complaints in the masticatory muscles and temporomandibular joints and with at least 1 diagnosis according to the German version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The level of impairment of OHRQoL was characterized by the OHIP summary score mean and its 95% confidence interval. OHRQoL was described for each of the 8 RDC/TMD diagnoses (Axis I) and the RDC/TMD Axis II measures (Graded Chronic Pain Scale [GCPS], jaw disability list, depression, and somatization). These findings were compared with the level of impairment of OHRQoL in the adult general population derived from a national sample (n = 2,026). RESULTS: Among the RDC/TMD Axis I measures, all diagnoses were correlated with much higher impacts compared to the normal population (means for all diagnoses were 32.8 to 53.7 versus 15.8 in the general population). All diagnoses had a similar level of impact except for disc displacement with reduction (which had a lower impact). There were larger differences in mean OHIP-G scores among subgroups of RDC/TMD Axis II measures than among subgroups of RDC/TMD Axis I characteristics. The strongest association was with GCPS, with mean OHIP scores of 33.3 for grade I, 48.1 for grade II, 71.7 for grade III, and 88.5 for grade IV. CONCLUSION: OHRQoL was markedly impaired in TMD patients. The level of OHRQoL varied across diagnostic categories but more across Axis II, ie, the psychosocial axis; the variation was reflected especially in their level of graded chronic pain.     

Depression and somatization in patients with temporomandibular disorders

STATEMENT OF PROBLEM: Psychological and behavioral traits may be important for the diagnosis and management of orofacial pain. PURPOSE: This study compared the levels of depression and somatization in patients in single and multiple research diagnostic criteria for temporomandibular disorders (RDC/TMD) diagnostic groups. MATERIAL AND METHODS: The RDC/TMD was established to allow standardization and replication of research into the most common forms of muscle- and joint-related research and is divided into 2 axes: axis I, clinical TMD, and axis II, pain-related disability and psychological status. One hundred seventeen patients (28 male and 89 female; mean age, 33.3 +/- 10.3 years) with RDC/TMD-defined clinical TMD were selected. The RDC/TMD history questionnaire and examination forms were input directly into computers with the use of a software program developed at the National University of Singapore (NUS TMDv1.1 software). Axis I and II variables were generated online and automatically archived for statistical analysis. Patients were subsequently classified into 7 groups based on the presence of the various RDC/TMD axis I diagnostic groups: group A, myofascial pain only (group I); group B, disk displacement only (group II); group C, other joint conditions such as arthralgia, osteoarthritis, and osteoarthrosis only (group III); group D, myofascial pain and disk displacement (groups I and II); group E, myofascial pain and other joint conditions (groups I and III); group F, disk displacement and other joint conditions (groups II and III); and group G, myofascial pain, disk displacement, and other joint conditions (groups I, II, and III). Differences in mean Symptom Checklist-90 scores between groups were compared by analysis of variance/Scheffé tests to contrast depression and somatization levels between the various axis I diagnostic groups (alpha=.05). RESULTS: The frequencies of the different groups were as follows: group A, 26.5%; group B, 29.9%; group C, 12.8%; group D, 6.0%; group E, 13.7%; group F, 4.3%; and group G, 6.8%. Approximately 39% of patients were clinically depressed, and 55% had moderate to severe somatization. Differences in mean depression and somatization with pain item scores were significant between groups (P<.05). CONCLUSION: Within the limitations of this study, patients diagnosed with myofascial pain and other joint conditions (group E) had significantly higher levels of depression (P=.03) and somatization (P=.03) than patients diagnosed with only disk displacements (group B).     

Interexaminer reliability of six orthopaedic tests in diagnostic subgroups of craniomandibular disorders

Interexaminer reliability is defined as the degree of consistency among examiners when making observations of the same clinical variable. In the present study, the interexaminer reliability of six orthopaedic tests was determined in a group of 79 patients with signs and/or symptoms of craniomandibular disorders (CMD), subdivided into three subgroups of patients with a mainly myogenous, a mainly arthrogenous, and a combined myogenous and arthrogenous disorder. Multi-test scores were composed for each test and combinations of tests for the three main symptoms of CMD, viz. pain, joint noises and restriction of movement. Although the orthopaedic tests showed different reliability scores, overall reliability of the determination of these three main symptoms of CMD was satisfactory.
In the subgroups, arthrogenous signs and symptoms could be determined reliably with the set of six tests, whereas the reliability of the tests in determining pain and joint noises in the myogenous group was rather low. It may be concluded that the tests are well suited to evaluate arthrogenous signs and symptoms, but that the clinician should be aware of erroneous results of the tests in evaluating pain of a myogenous origin.     

Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy‐two patients

Preoperative and postoperative temporomandibular disorders (TMDs) were observed in 72 patients before surgical‐orthodontic treatment and about 2 years after bilateral sagittal split osteotomy. Prevalence and degree of TMD were assessed using the modified clinical dysfunction index of Helkimo. A total of 49 women and 23 men (mean age 32 years) were included in the study. To find out which patients benefit most from the treatment, the sample was classified into subgroups—myogenous, arthrogenous, or both components of TMD. The prevalence of clicking and headache decreased significantly with the treatment, while the incidence of crepitation increased. In general, severity of the dysfunction was greatly reduced. Furthermore, multiple regression analysis showed that patients with excessive overjet and previous occlusal splint therapy benefit most from orthognathic treatment. In addition, patients with signs of mainly myogenous origin got more relief from their dysfunction than patients with mainly arthrogenous components of TMD. The results suggest that in patients with severe maxillomandibular discrepancy surgical‐orthodontic therapy is a good choice of treatment for reducing myogenous TMD pain and discomfort.     

Relationships between depression/somatization and self-reports of pain and disability

AIMS: To examine the relationship between depression and somatization and pain during muscle and joint palpation as well as limitations related to mandibular functioning (LRMF) in patients with temporomandibular disorders. METHODS: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) data for Axes I and II for 196 consecutive patients (56 men and 140 women) with a history of facial pain were obtained. The mean age of the predominantly Chinese patient population (83.2%) was 33.4 years (range 18 to 55 years). A computerized diagnostic system was used to collect the RDC/TMD history data. The Symptom Check List (SCL-90) depression and somatization scales were generated on-line and archived. The mean muscle pain (MP), joint pain (JP), and LRMF scores were computed with depression and somatization as main effects. Data were subjected to analysis of variance (Scheffé test) and Pearson's correlation at a significance level of .05. RESULTS: Depression scores ranged from 4.03 to 8.16 (MP), from 0.67 to 1.03 (JP), and from 0.30 to 0.38 (LRMF); somatization scores ranged from 2.64 to 7.75 (MP), from 0.58 to 1.00 (JP), and from 0.30 to 0.41 (LRMF). Interaction effects between depression and somatization were not significant. Patients with severe depression had significantly higher MP scores than normal patients or patients with moderate depression. Patients with moderate and severe somatization had significantly higher MP scores than normal patients. LRMF scores of patients with severe somatization were significantly greater than those who were normal or suffered from moderate somatization. No significant difference in JP scores was observed for depression and somatization scales. Correlations between depression/somatization and MP, JP, and LRMF scores were significant and positive but weak; coefficients ranged from 0.15 to 0.41. CONCLUSION: The results suggest that depression and somatization are related to the self-report of MP. In addition, severe somatization may be associated with an increase in jaw disability.     

Diagnoses based on the Research Diagnostic Criteria for Temporomandibular Disorders in a biracial population of young women

AIMS: To compare the clinical characteristics of diagnostic subtypes of temporomandibular disorders (TMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in terms of physical findings (Axis I) and psychosocial findings (Axis II) among Caucasian and African American young women. An ancillary goal was to assess the value of using self-reported TMD pain as a screening tool compared to RDC/TMD examinations. METHODS: A biracial community sample (n = 830) of young women 19 to 23 years old was screened for facial pain with the Chronic Pain Grade questionnaire. Patients were considered to be putative cases of TMD if they reported facial pain present within the last 6 months; putative controls had no facial pain history or jaw symptoms. Women with facial pain more than 6 months ago and jaw symptoms (jaw symptom-past pain, JSPP group) were added. 129 women were clinically examined for TMD diagnosis for final confirmation of case-control status. RESULTS: 41 of 43 Caucasian and 11 of 18 African American putative cases were confirmed as cases; 9 of 27 Caucasians, but 0 of 17 African Americans from the JSPP group were confirmed as cases. All 24 putative controls were confirmed as controls. Based on RDC/TMD Axis I, 80% of 61 cases were muscle-related diagnoses, 33% as disc-related diagnoses, and 48% as arthralgia/arthritis/arthrosis. Based on Axis I, there were no significant differences in diagnoses between African American and Caucasian women. Based on Axis II, cases had significantly greater depression (P = .002) and somatization with pain (P < .001) than controls as expected. African Americans had significantly greater somatization with pain than Caucasians (P = .020). There were no other significant racial differences. CONCLUSION: Among young women reporting facial pain, clinical TMD subtypes, pain impact, treatment utilization, and additional characteristics other than somatization with pain were similar between races. A high percentage of these young non-clinical cases presented severe depression and somatization.     

Craniomandibular stiffness in myogenous and arthrogenous CMD patients, and control subjects: a clinical and experimental investigation

summary The purpose of this study was to compare active maximum mouth opening, endfeel distance, and craniomandibular stiffness values of three crani- omandibular disorder (CMD) patient subgroups and a control group. The CMD patient subgroups consisted of myogenous pain patients and arthrogenous pain patients with a 'closed lock' and arthrogenous pain patients without a 'closed lock'. Both myogenous pain patients and the 'closed lock' patients showed great differences on all parameters (P < 0.05 – P < 0.001). However, the arthrogenous pain patients without a 'closed lock' revealed no statistical differences with the control group on any of the tested parameters.     

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.     

Symptoms of the cervical spine in temporomandibular and cervical spine disorders

This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region.     

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.     

Treatment received, treatment demand and treatment need for temporomandibular disorders in 35-year-old subjects

Especially in the last 10 years the aetiological significance of occlusion for TMD was relativated and the search for other alternative therapeutic strategies was intensified. For the treatment of myogenous and arthrogenous problems in TMD different kinds of physiotherapy are reported. Our intention of the present pilot study was focused on patients' perception of efficiency of different physiotherapeutic modalities and in relation to splint therapy.
A total of 187 patients of the TMD clinic in Düsseldorf were retrospectively asked to fill out a questionnaire with topics on physiotherapeutic home training programme (HTP), on professional physiotherapy (PP), on splint therapy (ST) and overall assessment of treatment effort (OATE). Eighty-one questionnaires could be analysed and evaluated in relation to three diagnostic TMD subgroups (myogenous, arthrogenous and mixed).
The HTP was positively assessed in 74%, PP in 70% and ST only in 38%. Fifty-one per cent of patients could realize HTP regularly per day, 86% of patients could realise PP regularly per week. The majority of patients felt improvement after some weeks/months of HTP resp. PP. No significant relation could be detected between TMD subgroups and patients'assessment to HTP, PP, ST and OATE.
Based on patients' assessment the results indicate that physiotherapeutic treatment modalities are highly efficient, whereas a differentiation between mentioned TMD subgroups does not seem to exist. A minority of patients (c. 20–25% of clinical cases) does not respond to dental-occlusal and physiotherapeutic therapy very well. Therefore, a multidisciplinary psychosocial-based treatment approach might be useful in these cases.     

Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy-two patients

Preoperative and postoperative temporomandibular disorders (TMDs) were observed in 72 patients before surgical-orthodontic treatment and about 2 years after bilateral sagittal split osteotomy. Prevalence and degree of TMD were assessed using the modified clinical dysfunction index of Helkimo. A total of 49 women and 23 men (mean age 32 years) were included in the study. To find out which patients benefit most from the treatment, the sample was classified into subgroups--myogenous, arthrogenous, or both components of TMD. The prevalence of clicking and headache decreased significantly with the treatment, while the incidence of crepitation increased. In general, severity of the dysfunction was greatly reduced. Furthermore, multiple regression analysis showed that patients with excessive overjet and previous occlusal splint therapy benefit most from orthognathic treatment. In addition, patients with signs of mainly myogenous origin got more relief from their dysfunction than patients with mainly arthrogenous components of TMD. The results suggest that in patients with severe maxillomandibular discrepancy surgical-orthodontic therapy is a good choice of treatment for reducing myogenous TMD pain and discomfort.     

Correlation of somatization,depression, and chronic pain with clinical findings of the temporomandibular disorders in asymptomatic women

ABSTRACT

Objective: The aim of this study was to correlate degree of depression, somatization, and chronic pain in asymptomatic women with clinical findings, using Research Diagnostic Criteria/Temporomandibular disorders (RDC/TMD).

Methods: A total of 200 female participants, ages 18–65, filled out a standard RDC/TMD axis II form for the assessment of chronic pain, disability, depression, and non-specific physical symptoms and underwent clinical examination of the temporomandibular joint. Correlation of clinical findings (axis I) and axis II assessment was performed using Spearman’s correlation test, with significance set at p < 0.05.

Results: There was a significant correlation between depression scores (p < 0.04), chronic pain (p < 0.001), and non-specific physical symptoms without questions about pain (p = 0.008).

Discussion: The highest scores on the Graded Chronic Pain Scale were observed in patients with arthralgia, while patients with myofascial pain scored higher on depression and somatization tests.     

Chronic myofascial pain, disk displacement with reduction and psychosocial factors in Finnish non-patients

This study aimed to determine chronic groups of myofascial pain and chronic disk displacement with reduction over a 1-year period, and to study the relationship between psychological status and these chronic subgroups of temporomandibular disorders (TMD) in non-patients. A total of 211 subjects (males 47%, mean age 46 years; standard deviation 6) attended examinations in 1999 and 2000 performed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Chronic myofascial pain was found in 7% and chronic disk displacement with reduction in 11% of subjects; new diagnoses were made in only 4% and 1% of the subjects, respectively. An increase in the level of somatization by 1 step increased the probability of having chronic myofascial pain by over 3 times (P = 0.006). Myofascial pain and disk displacement with reduction seem to be relatively common and fluctuating in nature in non-patients. As somatization associated significantly with myofascial pain, this should be borne in mind in the management of TMD. The results strengthen the rationale of the biopsychosocial orientation in health care.     

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.     

Psychologic status in patients with temporomandibular disorders

PURPOSE: The aim of this study was to investigate diferrences in the prevalence of depression and somatization scores in temporomandibular disorder (TMD) patients. MATERIALS AND METHODS: One hundred fifty-four patients with single and/or multiple RDC/TMD diagnoses were classified into 7 groups based on Axis I criteria. Somatization and depression scores from the Symptom Checklist-90 were compared between groups. RESULTS: The results of this investigation indicate that patients with myofascial pain and arthralgia psychologically differed from those with disc displacement. These results were in accordance with findings that support the notion that the pain induces psychologic sequelae, at least in relation to depression and somatization. CONCLUSION: It was concluded that psychologic factors play an important role in etiopathogenesis of TMD, as demonstrated by an increase in levels of depression and somatization in TMD patients.     

Diagnostic sub-types, psychological distress and psychosocial dysfunction in southern Chinese people with temporomandibular disorders

Summary  The study aimed to assess the distribution of temporomandibular disorders (TMD) sub-types, psychological distress and psychosocial dysfunction in southern Chinese people seeking treatment for TMD using Research Diagnostic Criteria for TMD (RDC/TMD) and investigate potential cross-cultural differences in sub-type prevalence and psychosocial impact. Eighty-seven consecutive patients (77 females; 10 males) with a mean age of 39·3 years (s.d. 12·8) newly referred to the specialist TMD clinic at the Prince Philip Dental Hospital, Hong Kong over a 20-month period took part in the study. RDC/TMD history questionnaire and clinical assessment data were used to derive Axis I and II findings. Group I muscle disorders were the most common and found in 57·5% of patients. Group II (disc displacement) disorders were found in 42·5% and 47·1% of the right and left temporomandibular joints (TMJ) respectively. Group III disorders (arthralgia/arthrosis/arthritis) were revealed in 19·5% and 23·0% of right and left TMJ's respectively. In the Axis II assessment, 42·5% of patients had moderate/severe depression scores, 59·7% had moderate/severe somatization scores and based on graded chronic pain scores 15·0% had psychosocial dysfunction (grade III and IV). While acknowledging the small sample size, the distribution of RDC/TMD Axis I and II diagnoses was fairly similar in Chinese TMD patients compared with Western and other Asian patient groups. However, in Chinese patients, myofascial pain with limited jaw opening and TMJ disc displacement with reduction were more common and a significant number experienced psychological distress and psychosocial dysfunction. The findings have implications for the management of TMD in Chinese people.