Abstract
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.
Perspective
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.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Risk factors for onset of chronic oro-facial pain–results of the North Cheshire oro-facial pain prospective population study.Pain. 2010; 149: 354-359
- Distribution and dose response of laboratory markers to alcohol consumption in a general population: Results of the study of health in Pomerania (SHIP).J Stud Alcohol. 2003; 64: 75-82
- Towards a theory of chronic pain.Prog Neurobiol. 2009; 87: 81-97
- Depression and pain comorbidity: A literature review.Arch Intern Med. 2003; 163: 2433-2445
- Etiologic theory and the prevention of temporomandibular disorders.Adv Dent Res. 1991; 5: 60-66
- Trauma in patients with temporomandibular disorders: Frequency and treatment outcome.J Oral Rehabil. 1996; 23: 91-96
- Temporomandibular disorders and chronic pain: Disease or illness?.J Prosthet Dent. 1994; 72: 29-38
- How may stressful experiences contribute to the development of temporomandibular disorders?.Clin Oral Investig. 2006; 10: 261-268
- The relationships among depression, pain, and masticatory functioning in temporomandibular disorder patients.J Orofac Pain. 2006; 20: 288-296
- [Dental occlusion and subjective temporomandibular joint symptoms in men and women. Results of the Study of Health in Pomerania (SHIP)].Schweiz Monatsschr Zahnmed. 2004; 114: 573-580
- Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: Results of a population-based Study of Health in Pomerania.Quintessence Int. 2004; 35: 143-150
- Association of mental distress with health care utilization and costs: A 5-year observation in a general population.Soc Psychiatry Psychiatr Epidemiol. 2009; 44: 835-844
- Specific somatoform disorder in the general population.Psychosomatics. 2003; 44: 304-311
- The link between childhood trauma and depression: Insights from HPA axis studies in humans.Psychoneuroendocrinology. 2008; 33: 693-710
- Study of Health in Pomerania (SHIP): A health survey in an East German region. Objectives and design of the oral health section.Quintessence Int. 2003; 34: 370-378
- Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD).J Dent Res. 2002; 81: 284-288
- Study of Health In Pomerania (SHIP): A health examination survey in an east German region: Objectives and design.Soz Praventivmed. 2001; 46: 186-194
- Genetic contributions to clinical pain and analgesia: Avoiding pitfalls in genetic research.J Pain. 2009; 10: 663-693
- Momentary pain and coping in temporomandibular disorder pain: Exploring mechanisms of cognitive behavioral treatment for chronic pain.Pain. 2009; 145: 160-168
- Factors associated with anxiety and depression in facial arthromyalgia.Pain. 2000; 84: 225-232
- Depression, anhedonia and anxiety in temporomandibular joint and other facial pain syndromes.Pain. 1981; 11: 73-84
- Physiology and neurobiology of stress and adaptation: Central role of the brain.Physiol Rev. 2007; 87: 873-904
- Oral parafunctions as risk factors for diagnostic TMD subgroups.J Oral Rehabil. 2010; 37: 157-162
- Personality characteristics and accompanying symptoms in temporomandibular joint dysfunction, headache, and facial pain.J Orofac Pain. 2000; 14: 52-58
- Muscle tenderness in different types of facial pain and its relation to anxiety and depression: A cross-sectional study on 649 patients.Pain. 2007; 131: 106-111
- Gender differences in associations between occlusal support and signs of temporomandibular disorders: Results of the population-based Study of Health in Pomerania (SHIP).Int J Prosthodont. 2005; 18: 232-239
- The many faces of the genetics contribution to temporomandibular joint disorder.Orthod Craniofac Res. 2008; 11: 125-135
- Current terminology and diagnostic classification schemes.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83: 61-64
- Epidemiology: An Introduction.Oxford University Press, New York, NY2002
- The effect of catechol-O-methyltransferase polymorphisms on pain is modified by depressive symptoms.Eur J Pain. 2012; 16: 878-889
- Temporomandibular disorders.N Engl J Med. 2008; 359: 2693-2705
- Nonpharmacologic approaches to the management of myofascial temporomandibular disorders.Curr Pain Headache Rep. 2001; 5: 421-431
- Association between symptoms of temporomandibular disorders and depression: An epidemiological study of the Northern Finland 1966 Birth Cohort.Cranio. 2001; 19: 183-187
- Association of symptoms of TMD and orofacial pain with alexithymia: An epidemiological study of the Northern Finland 1966 Birth Cohort.Cranio. 2001; 19: 246-251
- Generalized latent variable modelling: Multilevel, longitudinal and structural equation models.Chapman & Hall/CRC, Boca Raton, FL2004
- Influence of psychological factors on risk of temporomandibular disorders.J Dent Res. 2007; 86: 1120-1125
- Impact of physical symptoms on perceived health in the community.J Psychosom Res. 2008; 64: 265-274
- Depressive symptoms associated with symptoms of the temporomandibular joint pain and dysfunction syndrome.Psychosom Med. 1995; 57: 439-444
- Relaxing the rule of ten events per variable in logistic and Cox regression.Am J Epidemiol. 2007; 165: 710-718
- Size and burden of mental disorders in Europe–a critical review and appraisal of 27 studies.Eur Neuropsychopharmacol. 2005; 15: 357-376
- Screening for mental disorders: Performance of the Composite International Diagnostic - Screener (CID-S).Int J Meth Psychiat Res. 1999; 8: 59-70
- Relationships between depression/somatization and self-reports of pain and disability.J Orofac Pain. 2004; 18: 220-225
- Studies on contributing factors in temporomandibular disorders.Chin J Dent Res. 1999; 2: 7-20
- A modified poisson regression approach to prospective studies with binary data.Am J Epidemiol. 2004; 159: 702-706
Article info
Publication history
Published online: November 09, 2012
Accepted:
September 13,
2012
Received in revised form:
August 28,
2012
Received:
April 17,
2012
Footnotes
SHIP is part of the Community Medicine Research net of the University of Greifswald, Germany, which is funded by the Federal Ministry of Education and Research (grants no. 01ZZ9603, 01ZZ0103, and 01ZZ0403), the Ministry of Cultural Affairs and the Social Ministry of the Federal State of Mecklenburg-West Pomerania.
None of the authors reported potential conflicts of interest.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
