Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population

Plummer F., Manea L., Trepel D., McMillan D.

To systematically review the accuracy of the GAD-7 and GAD-2 questionnaires for identifying anxiety disorders.A systematic review of the literature was conducted to identify studies that validated the GAD-7 or GAD-2 against a recognized gold standard diagnosis. Pooled estimates of diagnostic test accuracy were produced using random-effects bivariate metaanalysis. Heterogeneity was explored using the I(2) statistic.A total of 12 samples were identified involving 5223 participants; 11 samples provided data on the accuracy of the GAD-7 for identifying generalized anxiety disorder (GAD). Pooled sensitivity and specificity values appeared acceptable at a cutoff point of 8 [sensitivity: 0.83 (95% CI 0.71-0.91), specificity: 0.84 (95% CI 0.70-0.92)] although cutoff scores 7-10 also had similar pooled estimates of sensitivity/specificity. Six samples provided data on the accuracy of the GAD-2 for identifying GAD. Pooled sensitivity and specificity values appeared acceptable at a cutoff of 3 [sensitivity: 0.76 (95% CI 0.55-0.89), specificity: 0.81 (95% CI 0.60-0.92)]. Four studies looked at the accuracy of the questionnaires for identifying any anxiety disorder.The GAD-7 had acceptable properties for identifying GAD at cutoff scores 7-10. The GAD-2 had acceptable properties for identifying GAD at a cutoff score of 3. Further validation studies are needed.

Türp J.C., Schmutzer G., Brähler E., Häuser W.

This study evaluated the prevalence of jaw pain as a local, regional, or widespread pain condition and its association with psychosocial variables in a large representative group of the general population from all regions in Germany. In two representative samples consisting of 2524 and 2515 subjects, respectively, the 7-day and 3-month pain prevalences were measured by using the Regional Pain Scale (RPS). Somatic symptom burden (somatization) and pain-related depression were assessed with the Patient Health Questionnaire and the Somatic Symptom Scale, respectively. Binary logistic regression was chosen to calculate the associations between demographic and psychological clinical predictor variables with jaw pain. The 7-day jaw pain prevalence was 4.0 % (95 % CI = 3.2–4.8). Of the subjects with jaw pain, only 9 % had local pain (1 pain site), while the remaining 91 % reported regional pain (2–5 pain sites), or widespread pain (6–19 pain sites). The 3-month prevalence of generally present jaw pain was 0.9 % (95 % CI = 0.6–1.0). Regional or widespread pain was present in 82 % of the participants. Jaw pain was predicted by somatic symptom burden (past 7 days, OR = 1.15 [95 % CI = 1.09–1.22]; past 3 months, OR = 1.13 [95 % CI = 1.02–1.25]), but not by depression. Most individuals with jaw pain have additional pain in other anatomical regions. They might also exhibit a greater risk for pain-associated somatic symptom burden. Assessment of pain distribution in the whole body and the use of a psychometric screening questionnaire for somatic symptom burden are recommended for individuals presenting with jaw pain in a clinical setting.

Moriarty A.S., Gilbody S., McMillan D., Manea L.

The Patient Health Questionnaire (PHQ-9) is a widely used screening tool for major depressive disorder (MDD), although there is debate surrounding its diagnostic properties. For the PHQ-9, we aimed to: 1. Establish the diagnostic performance at the standard cutoff point (10). 2. Compare the diagnostic performance at the standard cutoff point in different clinical settings. 3. Assess whether there is selective reporting of cutoff points other than 10.We searched three databases - Embase, MEDLINE and PSYCHInfo - and performed a reverse citation search in Web of Science. We selected for inclusion studies of any design that assessed the PHQ-9 in adult populations against recognized gold-standard instruments for the diagnosis of either Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria for major depression. Included studies had to report sufficient information to calculate 2*2 contingency tables. Data extraction and synthesis were performed independently by two researchers. For the included studies, we calculated pooled sensitivity, pooled specificity, positive likelihood, negative likelihood ratio and diagnostic odds ratio for cutoff points 7 to 15.Thirty-six studies (21,292 patients) met inclusion criteria. Pooled sensitivity for cutoff point 10 was 0.78 [95% confidence interval (CI), 0.70-0.84], and pooled specificity was 0.87 (95% CI, 0.84-0.90). At this cutoff, the PHQ-9 is a better screener in primary care than secondary care settings. No conclusions could be drawn at cutoff points other than 10 due to selective reporting of data.For MDD, the PHQ-9 has acceptable diagnostic properties at cutoff point 10 in different settings. We recommend that future studies report the full range of cutoff points to allow exploration of optimal cutoff points in different settings.

Shetty A., James L., Nagaraj T., Abraham M.

Vilanova L.S., Garcia R.C., List T., Alstergren P.

To investigate the difference in diagnostic reliability between self-instructed examiners and examiners taught in a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) course and if the reliability of self-instructed examiners improves after the course. Six examiners were divided into three groups: (1) formal two-day training and calibration course at a DC/TMD training center (Course group), (2) self-teaching through documents and movie (Self group) with three examiners on each and the Self group later participated in the course (Self + course group). Each group examined sixteen subjects, total of 48 volunteers (36 patients with TMD and 12 asymptomatic) and the reliabilities in relation to the diagnoses derived by a Reference Standard Examiner were compared by Cohen’s Kappa coefficient. The reliability was good to excellent in all three groups of examiners for all DC/TMD diagnoses, except for Myofascial pain with referral in the Self + course group. The course seemed to improve the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence. This study shows that the diagnostic reliability of formal DC/TMD training and calibration and DC/TMD self-instruction are similar, except for subgroups of Myalgia. Thus, self-instruction seems to be possible to use to diagnose the most common TMDs in general dental practice. The course further improves the reliability regarding Myalgia and Arthralgia at the same time as the examiners experienced the course to be valuable for self-perceived ability and confidence.

Visscher C.M., Ligthart L., Schuller A.A., Lobbezoo F., Jongh A.D., van Houtem C.M., Boomsma D.I.

Manea L., Gilbody S., McMillan D.

The depression module of the Patient Health Questionnaire-9 (PHQ-9) is a widely used depression screening instrument in nonpsychiatric settings. The PHQ-9 can be scored using different methods, including an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and a cut-off based on summed-item scores. The algorithm was the originally proposed scoring method to screen for depression. We summarized the diagnostic test accuracy of the PHQ-9 using the algorithm scoring method across a range of validation studies and compared the diagnostic properties of the PHQ-9 using the algorithm and summed scoring method at the proposed cut-off point of 10.We performed a systematic review of diagnostic accuracy studies of the PHQ-9 using the algorithm scoring method to detect major depressive disorder (MDD). We used meta-analytic methods to calculate summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for diagnosing MDD of the PHQ-9 using algorithm scoring method. In studies that reported both scoring methods (algorithm and summed-item scoring at proposed cut-off point of ≥10), we compared the diagnostic properties of the PHQ-9 using these methods.We found 27 validation studies that validated the algorithm scoring method of the PHQ-9 in various settings. There was substantial heterogeneity across studies, which makes the pooled results difficult to interpret. In general, sensitivity was low whereas specificity was good. Thirteen studies reported the diagnostic properties of the PHQ-9 for both scoring methods. Pooled sensitivity for algorithm scoring method was lower while specificities were good for both scoring methods. Heterogeneity was consistently high; therefore, caution should be used when interpreting these results.This review shows that, if the algorithm scoring method is used, the PHQ-9 has a low sensitivity for detecting MDD. This could be due to the rating scale categories of the measure, higher specificity or other factors that warrant further research. The summed-item score method at proposed cut-off point of ≥10 has better diagnostic performance for screening purposes or where a high sensitivity is needed.

Schiffman E., Ohrbach R., Truelove E., Look J., Anderson G., Goulet J., List T., Svensson P., Gonzalez Y., Lobbezoo F., Michelotti A., Brooks S.L., Ceusters W., Drangsholt M., Ettlin D., et. al.

Bair E., Ohrbach R., Fillingim R.B., Greenspan J.D., Dubner R., Diatchenko L., Helgeson E., Knott C., Maixner W., Slade G.D.

Incidence of temporomandibular disorder (TMD) was predicted with multivariable models that used putative risk factors collected from initially TMD-free individuals in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study. The 202 baseline risk factors included sociodemographic and clinical characteristics, measures of general health status, experimental pain sensitivity, autonomic function, and psychological distress. Study participants (n = 2,737) were then followed prospectively for a median of 2.8 years to ascertain cases of first-onset TMD. Lasso regression and random forest models were used to predict incidence of first-onset TMD using all of the aforementioned measures. Variable importance scores identified the most important risk factors, and their relationship with TMD incidence was illustrated graphically using partial dependence plots. Two of the most important risk factors for elevated TMD incidence were greater numbers of comorbid pain conditions and greater extent of nonspecific orofacial symptoms. Other important baseline risk factors were preexisting bodily pain, heightened somatic awareness, and greater extent of pain in response to examiners' palpation of the head, neck, and body. Several demographic variables persisted as risk factors even after adjusting for other OPPERA variables, suggesting that environmental variables not measured in OPPERA may also contribute to first-onset TMD.Multivariable methods were used to identify the most important predictors of first-onset TMD in the OPPERA study. Important variables included comorbid pain conditions, preexisting pain, and somatic awareness. Demographic characteristics, which probably reflect environmental variables not measured in OPPERA, also appear to play an important role in the etiology of TMD.

Fillingim R.B., Ohrbach R., Greenspan J.D., Knott C., Diatchenko L., Dubner R., Bair E., Baraian C., Mack N., Slade G.D., Maixner W.

Case-control studies have consistently associated psychological factors with chronic pain in general and with temporomandibular disorder (TMD) specifically. However, only a handful of prospective studies have explored whether preexisting psychological characteristics represent risk factors for first-onset TMD. The current findings derive from the prospective cohort study of the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) cooperative agreement. For this study, 3,263 TMD-free participants completed a battery of psychological instruments assessing general psychological adjustment and personality, affective distress, psychosocial stress, somatic symptoms, and pain coping and catastrophizing. Study participants were then followed prospectively for an average of 2.8 years to ascertain cases of first-onset of TMD, and 2,737 provided follow-up data and were considered in the analyses of TMD onset. In bivariate and demographically adjusted analyses, several psychological variables predicted increased risk of first-onset TMD, including reported somatic symptoms, psychosocial stress, and affective distress. Principal component analysis of 26 psychological scores was used to identify latent constructs, revealing 4 components: stress and negative affectivity, global psychological and somatic symptoms, passive pain coping, and active pain coping. In multivariable analyses, global psychological and somatic symptoms emerged as the most robust risk factor for incident TMD. These findings provide evidence that measures of psychological functioning can predict first onset of TMD. Future analyses in the OPPERA cohort will determine whether these psychological factors interact with other variables to increase risk for TMD onset and persistence.This article reports that several premorbid psychological variables predict first-onset TMD in the OPPERA study, a large prospective cohort study designed to discover causal determinants of TMD pain. Measures of somatic symptoms were most strongly associated with TMD onset, but perceived stress, previous life events, and negative affect also predicted TMD incidence.

Litt M.D., Porto F.B.

Abstract The purpose of the present study was to determine if we could identify a specific subtype of temporomandibular disorder (TMD) pain patients that does not respond to treatment. Patients were 101 men and women with chronic TMD pain recruited from the community and randomly assigned to 1 of 2 treatment conditions: a standard conservative care (STD) condition or a standard care plus cognitive-behavioral therapy condition (STD + CBT) in which patients received all elements of STD but also received cognitive-behavioral coping skills training. Growth mixture modeling, incorporating a series of treatment-related predictors, was used to distinguish several distinct classes of responders or nonresponders to treatment based on reported pain over a 1-year follow-up period. Results indicated that treatment nonresponders accounted for 16% of the sample and did not differ from treatment responders on demographics or temporomandibular joint pathology, but that they reported more psychiatric symptoms, poorer coping, and higher levels of catastrophizing. Treatment-related predictors of membership in treatment responder groups versus the nonresponder group included the addition of CBT to STD, treatment attendance, and decreasing catastrophization. It was concluded that CBT may be made more efficacious for TMD patients by placing further emphasis on decreasing catastrophization and on individualizing care. Perspective This article provides evidence that the TMD chronic pain population is heterogeneous and that a subsample of patients will be unresponsive to standard or psychosocial approaches. The addition of CBT to treatment may be helpful for this group, but new individualized approaches will be needed to treat all patients effectively.

Kocalevent R., Hinz A., Brähler E.

The nine-item depression module from the Patient Health Questionnaire (PHQ-9) is widely used as an open access screening instrument for depression in different health care and community settings; thus far, normative data from the general population are still scarce. The objectives of the study were to generate normative data and to further investigate the construct validity and factor structure of the PHQ-9 in the general population.Nationally representative face-to face household surveys were conducted in Germany between 2003 and 2008 (n=5018). The survey questionnaires included the PHQ-9, the Satisfaction with Life Scale, the 12-item Short Form Health Survey (SF-12) for the measurement of health-related quality of life and demographic characteristics.Normative data for the PHQ-9 were generated for both genders (53.6% female) and different age levels [mean age (S.D.) of 48.9 (18.1) years]. Women had significantly higher mean (S.D.) scores compared with men [3.1 (3.5) vs. 2.7 (3.5)]. A prevalence rate of moderate to high severity of depressive symptoms of 5.6% was identified. Intercorrelations with depression were highest for the Mental Component Scale of the SF-12, followed by the Physical Component Scale of health-related quality of life, and life satisfaction. Results supported a one-factor model of depression.The normative data provide a framework for the interpretation and comparisons of depression with other populations. Evidence supports reliability and validity of the unidimensional PHQ-9 as a measure of depression in the general population.

American Psychiatric Association

Kindler S., Samietz S., Houshmand M., Grabe H.J., Bernhardt O., Biffar R., Kocher T., Meyer G., Völzke H., Metelmann H., Schwahn C.

Previous studies have associated depression and temporomandibular joint disorders (TMDs). The temporality, however, remains to be clarified. Most patient studies have selected subjects from treatment facilities, whereas in epidemiological studies a clinical examination has not been performed. In this study the 5-year follow-up data of the population-based Study of Health in Pomerania (SHIP) were analyzed. To estimate the effect of symptoms of depression and those of anxiety on the risk of TMD pain, the Composite International Diagnostic-Screener (CID-S) and a clinical functional examination with palpation of the temporomandibular joint and the masticatory muscles were used. After exclusion of subjects having joint pain at baseline, a sample of 3,006 Caucasian participants with a mean age of 49 years resulted. Of those, 122 participants had signs of TMD joint pain upon palpation. Subjects with symptoms of depression had an increased risk of TMD joint pain upon palpation (rate ratio: 2.1; 95% confidence interval: 1.5-3.0; P < .001). Anxiety symptoms were associated with joint and with muscle pain. The diagnosis, prevention, and therapy of TMD pain should also consider symptoms of depression and those of anxiety, and appropriate therapies if necessary.Depressive and anxiety symptoms should be considered as risk factors for TMD pain. Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination. These findings may support decision-making in treating TMD.

Manea L., Gilbody S., McMillan D.

Background: The brief Patient Health Questionnaire (PHQ-9) is commonly used to screen for depression with 10 often recommended as the cut-off score. We summarized the psychometric properties of the PHQ-9 across a range of studies and cut-off scores to select the optimal cut-off for detecting depression. Methods: We searched Embase, MEDLINE and PsycINFO from 1999 to August 2010 for studies that reported the diagnostic accuracy of PHQ-9 to diagnose major depressive disorders. We calculated summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for detecting major depressive disorder at different cut-off scores and in different settings. We used random-effects bivariate meta-analysis at cutoff points between 7 and 15 to produce summary receiver operating characteristic curves. Results: We identified 18 validation studies (n = 7180) conducted in various clinical settings. Eleven studies provided details about the diagnostic properties of the questionnaire at more than one cut-off score (including 10), four studies reported a cut-off score of 10, and three studies reported cut-off scores other than 10. The pooled specificity results ranged from 0.73 (95% confidence interval [CI] 0.63–0.82) for a cut-off score of 7 to 0.96 (95% CI 0.94–0.97) for a cut-off score of 15. There was major variability in sensitivity for cut-off scores between 7 and 15. There were no substantial differences in the pooled sensitivity and specificity for a range of cut-off scores (8–11). Interpretation: The PHQ-9 was found to have acceptable diagnostic properties for detecting major depressive disorder for cut-off scores between 8 and 11. Authors of future validation studies should consistently report the outcomes for different cut-off scores.

Shkarin V.V., Yarygina E.N., Makedonova Y.A., Pavlova-Adamovich A.G., Kabytova M.V., Afanasyeva O.Y.

To understand the processes occurring during the development of temporomandibular myofascial pain syndrome, a clear description of the anatomical components is necessary. In the literature, the term «stomatognathic system» is used for this, the elements of which are the temporomandibular joint, masticatory muscles and the dental periodontal complex. Each component of the system is influenced by a number of factors, primarily psychological, which causes the subjectivization of clinical manifestations from headaches to pathological tooth cutting and the development of temporomandibular joint dysfunction. One of the methods of treating this pathology is to inject botulinum toxin type A into the chewing muscles. However, the question of the choice of methods of administration of botulinum toxin and its dosage remains relevant.Materials and methods. Botulinum toxin injections were performed outside and intraoral in 30 patients with temporomandibular myofascial pain syndrome. The effectiveness of the therapy was evaluated on the basis of clinical examination data, analysis of the degree of mouth opening before the start of treatment, after 14 days, 6 and 12 months.Results. The high efficiency of botulinum toxin type A injections in the treatment of the above pathology has been proven.Conclusion. It is important to evaluate the effectiveness of treatment based on the developed clinical examination methods, if necessary, correct it in a timely manner at all stages of treatment and follow-up of patients with temporomandibular myofascial pain syndrome.

Alqarni A., Hosmani J., Alassiri S., A. Alqahtani A.M., Alfaifi A., Al Jazea S.A.

Background Temporomandibular disorders (TMDs) comprise an extensive spectrum of conditions that originate from diverse complex components of the temporomandibular joint. It is generally acknowledged that the biopsychosocial model is the preeminent framework for understanding the aetiology of TMDs. Anxiety, depression, and tension are among the psychological disorders that are commonly observed in dental students. The current research probed the propinquity of psychosocial stressors and TMD-like symptoms among clinical dental undergraduates residing in the Aseer region of Saudi Arabia, with a specific emphasis on the functional implications for their overall well-being. Methods This research included 89 clinical dentistry students who completed online questionnaires. The Patient-Reported Outcomes Measurement Information System (PROMIS) and Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD) were used in these surveys. The trait-related attributes of TMD impacting the oral health profile were assessed using principal component analysis. Demographic factors for anxiety and TMD were examined using linear regression. The psychosocial and functional variables of the OHIP-TMD were compared with those of anxiety in the general regression system. Results The mean Oral Health Impact Profile (OHIP) value was 0.60, with a standard deviation of 0.61, indicating that the majority of respondents reported no or infrequent impacts on their oral health profile. Gender was a significant predictor of OHIP scores (P < 0.05), with females reporting higher scores. Despite these higher scores among females, the overall impact on oral health remained minimal for most respondents. The average PROMIS score was 11.12, with a standard deviation of 3.84. The PROMIS regression analysis on demographic variables yielded an R2 value of 0.092, F(4,78) = 5.691, with significance at P < 0.05. Gender emerged as the most significant predictor of PROMIS scores (P < 0.05), with females reporting higher scores. Once again, despite the higher scores among females, the overall impact remained low for most respondents. An analysis using a general linear model revealed a significant correlation between heightened anxiety levels and an increase in both psychosocial problems and physical function. Conclusion Although the majority of respondents reported minimal impacts on their oral health, anxiety remained a significant issue among female clinical dentistry students at the College of Dentistry in Aseer Province, Kingdom of Saudi Arabia. This anxiety was closely linked with psychological distress and impaired oral physical function. Beyond the realm of dental health, anxiety also had a profound effect on academic performance and student engagement. Therefore, addressing student anxiety is essential for enhancing overall well-being and academic success.

Signorelli N.S., Moura C.C., Borges R.F., Simamoto Júnior P.C., Gibbs J.L.

Bailey R., Oba E.C., Allen R.

Men who have sex with men (MSM) living with HIV tend to experience a range of mental health issues, in particular generalised anxiety disorder (GAD), often caused and maintained by psychosocial variables including HIV stigma, discrimination, self-esteem issues, substance abuse and loneliness. This is particularly problematic in countries like Nigeria where same sex activity is illegal and can result in up to 14 years imprisonment. An important psychological variable that may contribute to the experience of GAD are metacognitive beliefs. Participants ( N = 311) completed measures to examine the relationship between these variables. Results indicated that metacognition was associated with, and significantly predicted, GAD in this population. Moderation analysis showed that the effect of HIV stigma on GAD was explained by the proposed interaction with metacognition. Findings suggest that metacognition may be an important variable in explaining GAD symptoms in MSM living with HIV in Nigeria.

Paludo B., Trevizan P.C., Boamah N.A., Rigo L.

ABSTRACT BACKGROUND: Temporomandibular disorders (TMD) are a major cause of non-dental pain in the oral and facial regions. OBJECTIVE: This study aimed to determine the prevalence and severity of TMD and anxiety among academics and to investigate the relationship between TMD and its associated factors. DESIGN AND SETTING: This cross-sectional study included a sample of 295 academics undertaking health courses at a university in Brazil. METHODS: The Simplified Anamnesis Index and Beck Anxiety Inventory were used to evaluate TMD and assess anxiety, respectively. Data were statistically analyzed using relative and absolute frequencies of variables. In the bivariate analysis, Pearson’s chi-square test was used, and in the multivariate analysis, raw and adjusted binary logistic regressions were used to obtain the odds ratio (OR) and respective 95% confidence intervals. Statistical significance was set at P < 0.05. RESULTS: The average age of academics was 22.95 (standard deviation ± 6.14) years, predominantly comprising women (82.7%), whites (90.8%), and singles (86.6%). The findings revealed that 81.2% of academics had TMD and 50.5% exhibited symptoms of anxiety. Academics with anxiety were three times more likely to have TMD (OR = 3.6) than those without anxiety. CONCLUSION: A significant association between anxiety and TMD was observed in academics. The prevalence of TMD was high, with academics with anxiety having a high likely to develop TMD. These findings highlight the importance of addressing mental health concerns in addition to physical health, as they are often related.

Lima Bastos P., Fontenele R., de Oliveira D., D'Escragnolle Taunay T.C., Fagundes C., Salles Ottoboni G., Moura Batista L.

ABSTRACTBackgroundTemporomandibular disorders (TMD) are a multimodal group of orofacial pain syndromes that rank behind only chronic low back pain in the list of most prevalent musculoskeletal conditions causing pain and disability. Previous studies have recorded high rates of comorbid anxiety, depression, and poor sleep quality among TMD patients.MethodsEighty five outpatients recruited from Rhode Island Hospital's Latino and Portuguese Mental Health Programs completed the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the Pittsburgh Sleep Quality Index questionnaire (PSQI). The latest meta‐analysis of TMD prevalence in the general population was used for the reference population (n = 3159).ResultsThe most prevalent psychiatric disorders were depressive disorders (75.3%), anxiety disorders (57.6%), and sleep–wake disorders (47.1%). Fifty patients (58.8%) met criteria for TMD, versus 29.3% in the reference population (p < 0.001). In our sample, the PSQI cut‐off for poor sleep was crossed in 96.2% of patients with TMD and 82.9% of those without TMD (p = 0.041).ObjectivesWe sought to establish the prevalence of TMD in a significant sample of psychiatric outpatients, considering their psychiatric diagnoses and sleep quality.ConclusionThe very high prevalence of TMD among patients with depression, anxiety, and sleep disorders reinforces their association and alerts us to the possibility of TMD constituting a widespread, though largely ignored, comorbidity of psychiatric outpatients that may be impacting their mental health outcomes. Further studies are needed to clarify the value of screening this population for TMD and to establish which cases merit treatment.

Iarygina E.N., Shkarin V.V., Makedonova Y.A., Dyachenko S.V.

Heikkinen E.V., Kakko N., Näpänkangas R., Vuollo V., Harila V., Sipilä K.

Stephanus Brandsma D., Hughes D., Ferro A., Connor S., Fan K.

Karimi P., Zojaji S., Fard A.A., Nateghi M.N., Mansouri Z., Zojaji R.

AbstractIntroductionAs of 2020, about 21% of adults in the United States have a diagnosable mental health disorder, excluding substance use and developmental disorders. Depression, predicted by the WHO to be the leading cause of disease burden by 2030, is linked to various systemic conditions and has been associated with poor oral health. Both behavioral factors, like poor dental hygiene and irregular visits, and biological mechanisms, such as changes in salivary immunity, contribute to this connection, which impacts overall well‐being and quality of life. This systematic review aims include: (1) Does tooth loss affect depression? (2) Does oral pain, such as that experienced during chewing and speaking, impact depression? (3) Does oral functionality, including chewing and speaking, influence depression? (4) Does overall oral health affect depression?MethodsWe conducted a systematic search of PubMed, EBSCO host, Medline, and Google Scholar databases from January 2000 to June 2024 using relevant keywords. Studies examining the impact of oral health parameters (tooth loss, oral pain, oral functionality, overall oral health) on depression were included. Articles were included if (1) full text manuscripts in English were available, (2) the study described the association of oral health and depression, and (3) the independent value was an oral related factor and the dependent value was depression. The following were excluded from our analysis: (1) any articles where oral factors were not the independent value, (2) systematic reviews, (3) case reports, and (4) duplicate studies among our databases. Thirty‐one studies met the inclusion criteria.ResultsTooth loss, oral pain, and impaired oral functionality were consistently associated with increased depressive symptoms across the included studies. Greater tooth loss was linked to higher odds of both onset and progression of depression. Oral pain exacerbated depressive symptoms, while difficulties in chewing or speaking were associated with elevated risks of depression.ConclusionThere is a bidirectional relationship between oral health and depression, highlighting the urgent need for comprehensive public health initiatives. Integrating oral health assessments into routine medical care, and developing targeted interventions are crucial steps to mitigate the impact of poor oral health on mental health outcomes.

Cui Y., Kang F., Li X., Shi X., Zhang H., Zhu X.

IntroductionTemporomandibular disorders (TMD) have a high prevalence and complex etiology. The purpose of this study was to apply a machine learning (ML) approach to identify risk factors for the occurrence of TMD in adults and to develop and validate an interpretable predictive model for the risk of TMD in adults.MethodsA total of 949 adults who underwent oral examinations were enrolled in our study. 5 different ML algorithms were used for model development and comparison, and feature selection was performed by feature importance ranking and feature decreasing methods. Several evaluation indexes, including the area under the receiver-operating-characteristic curve (AUC), were used to compare the predictive performance. The precision-recall curve (PR), calibration curve, and decision curve analysis (DCA) further assessed the accuracy and clinical utility of the model.ResultsThe performance of the random forest (RF) model was the best among the 5 ML models. An interpretable RF model was developed with 7 features (gender, malocclusion, unilateral chewing, chewing hard substances, grinding teeth, clenching teeth, and anxiety). The AUCs of the final model on the training set, internal validation set, and external test set were 0.892, 0.854, and 0.857, respectively. Calibration and DCA curves showed high accuracy and clinical applicability of the model.DiscussionAn efficient and interpretable TMD risk prediction model for adults was successfully developed using the ML method. The model not only has good predictive performance, but also enhances the clinical application value of the model through the SHAP method. This model can provide clinicians with a practical and efficient TMD risk assessment tool that can help them better predict and assess TMD risk in adults, supporting more efficient disease management and targeted medical interventions.

Tian Y., Tan Y., Yang M., Lv X., Zheng Y., Zhang Q., Sun Y., Wang J., Xiong X.

Yarygina E.N., Shkarin V.V., Makedonova Y.A., Kurezov A.K., Devyatchenko L.A., Afanasyeva O.Y.

Relevance. Due to the high prevalence of myofascial pain syndrome of the masticatory muscles, the issue of treatment of this pathology remains relevant. Due to the heterogeneity of the severity of clinical manifestations, these additional examination methods, the development of a treatment plan by a dentist causes certain difficulties. Materials and methods. Based on the data of a clinical and functional examination of 102 people aged 18 to 35 years, a gradation of the severity of MBS of the masticatory muscles was developed. In a clinical study, the presence and severity of pain during palpation, the degree of mouth opening, and an assessment of functional activity on the MAS scale were determined. Ultrasound examination was used to study the indicators of the area and thickness of the cross-section of the chewing muscles, visualization and size of trigger points. According to the electromyographic study, a comparative analysis of the average amplitude of the masticatory muscle, the total biopotential, and an assessment of the symmetry of the masticatory muscles was carried out. Results. The data obtained made it possible to develop a gradation of the severity of MBS by 3 degrees, depending on the indicators (mild, moderate, high). Conclusion. The development of this graduation will allow for an individual patient-oriented approach to the treatment of this category of people, which will contribute to improving the quality of medical care at a dental appointment

Ferreira C.C., Lima K.R., Dias-Peixoto M.F., Orlando D.R., Castelo P.M., Pereira L.J., Francelino Andrade E.

Background and Purpose The COVID-19 pandemic exacerbated pain and joint mobility outcomes in patients with temporomandibular disorders (TMD), being that effective treatments are of clinical interest. We aimed to evaluate the effects of manual therapy (MT) and dry needling (DN), compared to cognitive-behavioral therapy/control (CO), on pain, articular mobility, and fear of COVID-19 in patients with TMD. Materials and methods Sixty participants with myofascial TMD were randomly assigned to three groups: MT, DN, and CO. Participants received four weeks of treatment (30 minutes per week). The participants completed the Fear of COVID- 19 Scale, the Visual Analog Scale, and mandibular mobility was assessed. Data were collected before the intervention (T1), after the last treatment session (T2), and 30 days after the end of treatment (T3). The data were analyzed using two-way Mixed-Design ANOVA, considering the group effect (DN x MT x CO), time (T1, T2, and T3), and the interaction time*group in the observed variance of outcomes. Results We observed an interaction effect of time*group for maximum mouth opening, protrusion, and pain. The maximum mouth opening increased in the DN and MT groups (p=0.005), while protrusion increased in the DN group (p=0.007; test power=97%, large effect size). A decrease in pain scores over time was observed in the DN and MT groups (p99%, large effect size). The fear of COVID-19 score decreased in the DN and MT groups after 30 days (p=0.033). Conclusion DN and MT improve pain, joint mobility, and fear of COVID-19 in patients with TMD.

Niszezak C.M., Sonza A., Santos G.M.

Introduction Some studies claim that functional changes in TMD affect the stomatognathic system (SS) and could contribute to the emergence of pain and changes in postural control. Purpose To characterize and to compare pain, dynamic postural control (DPC), mental health and impact of oral health (QoL) in different types of temporomandibular disorders (TMD). Method Cross-sectional study with 116 participants evaluated by a validated TMD protocol and divided into three groups, muscle TMD (TMD-M, n = 32), joint TMD (TMD-J, n = 30) and muscle-joint TMD (TMD-MJ, n = 54).Chewing pain, DPC, anxiety, depression, sleep quality and impact of oral health on QoL were measured. One-way ANOVA, Kruskal-Wallis, Pearson's Chi-square test and eta-square effect size were used to data analysis. Results TMD-J showed less subjective pain than TMD-M (p = 0.014) and TMD-MJ (p = 0.021).TMD-J also presented greater height (p = 0.022) and body mass (p = 0.041) than the TMD-MJ and TMD-M, respectively. The DPC evaluation with sensory organization test 1 (SOT1, open eyes, platform and cabin fixed) in the medio-lateral direction (ML) was higher (p = 0.027) for TMD-J than TMD-M. TMD-MJ had a higher level of depression (p = 0.041) than TMD-J, and a greater impact of oral health on QoL (p = 0.035) than TMD-M. Conclusion Masticatory pain was lower in the TMD-J. There was a reduction in DPC in the ML of SOT1 in the TMD-J owing to the greater height of the patients in this group. The TMD-MJ had higher levels of depression and negative impact of oral health. In general, poor oral health reduces QoL in patients with TMD.