Determination of Chronic Pain, Anxiety, Depression and Perceived Stress in Adults With Temporomandibular Disorders

The aim of the study was to asses levels and relationship of chronic pain, anxiety, depression and perceived stress in TMD patients .

Temporomandibular disorders (TMD) is an umbrella term describing a heterogenic group of conditions concerning masticatory muscles, temporomandibular joints and surrounding hard and soft structures. Most common signs and symptoms of TMD are: orofacial pain, joint sounds such as clicking or crepitus and limitation in jaw movements . Temporomandibular disorder (TMD) is the most common cause of orofacial pain and after chronic low back pain, it is the second cause of pain and disability in the musculoskeletal system. TMDs are considered as a global problem decreasing quality of life and potentially causing chronic pain, in daily activity limitation, anxiety, depression, general health problems, decreased work productivity and can lead to work absences.

The etiology of TMD is complex, multifactorial, and in many cases unclear. The biopsychosocial model tends to cover a broad spectrum of different conditions and aspects that may play a role in TMD occurrence. It integrates biological factors (structural disorders and disturbance in function) with psychosocial aspects (emotions, cognition, behaviors, reaction to stress and pain in context of family, workplace and community) .

The prevalence of TMD is estimated between 5-12% of the general population . About 26-30% of young adults present at least one symptom of TMD . The prevalence of TMD in adults over 45 years old is estimated between 2-7%.and in patients over 65 years old 3-5% . It is often suggested that women are more often affected by TMD than men.

Many studies conducted so far indicate the existence of a strong relationship between TMD and psychosocial impairment including depression, somatization and anxiety. Patients with chronic pain condition have been found to exhibit high level of psychosocial impairments compared with painless controls . Many authors also indicate that the psychosocial factors reduce the response to the conservative treatment used among patients with TMD (occlusal splint therapy) and may increase the risk of the chronic form of this disorders.Therefore, the diagnosis of various types of psychosocial disorders among TMD patients is very important, because it will influence the appropriate clinical decisions and correct management protocol.

The available data on the relationship between TMD and psychosocial impairment contribute a lot to both the diagnosis and management of TMD. Unfortunately, the above data do not concern the prevalence and epidemiology of chronic pain, depression, anxiety and perceived stress in the polish population. Therefore, the data collected by the cited authors cannot be compared and the conclusions drawn from them cannot be used to the Polish population.

Based on these premises, the objectives of this study are to determine the level and prevalence of chronic pain, anxiety, depression and perceived stress among adult TMD patients from western Poland, and to use these data to identify and management of TMD.

A total of 219 adult patients from outpatient clinic for temporomandibular disorders participated in this retrospective study. All patients filled GCPS, GAD-7, PHQ-9 and PSS-10 questionnaires, and had TMD diagnosis based on DC/TMD examination carried out by an experienced dentist. After that statistical analysis was conducted.

Eligibility Criteria:
Inclusion Criteria:

* Inclusion criteria for this study were age equal or above 18 years old and diagnosis of TMD based on DC/TMD examination form.

Exclusion Criteria:

* The exclusion were severe neurological or mental diseases, taking medications that significantly affect the neuromuscular function, alcohol and/or drug addiction, active cancer diagnosis, pregnancy.