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Signs and Symptoms of First-Onset TMD and Sociodemographic Predictors of Its Development: The OPPERA Prospective Cohort Study

  • Gary D. Slade
    Correspondence
    Address reprint requests to Gary D. Slade, BDSc, DDPH, PhD, Department of Dental Ecology, Room 4501E, Koury Oral Health Sciences, UNC School of Dentistry, CB #7455, Chapel Hill, NC 27599-7450.
    Affiliations
    Regional Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Eric Bair
    Affiliations
    Regional Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    §Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Joel D. Greenspan
    Affiliations
    Departments of Oral and Maxillofacial Surgery and Neural and Pain Sciences, and Brotman Facial Pain Center, University of Maryland School of Dentistry, Baltimore, Maryland
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  • Ronald Dubner
    Affiliations
    Departments of Oral and Maxillofacial Surgery and Neural and Pain Sciences, and Brotman Facial Pain Center, University of Maryland School of Dentistry, Baltimore, Maryland
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  • Roger B. Fillingim
    Affiliations
    Department of Community Dentistry and Behavioral Science, University of Florida, College of Dentistry, and Pain Research and Intervention Center of Excellence, Gainesville, Florida
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  • Luda Diatchenko
    Affiliations
    Regional Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    §Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Anesthesia, and Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
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  • William Maixner
    Affiliations
    Regional Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    §Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    §§Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Charles Knott
    Affiliations
    Battelle Memorial Institute, Durham, North Carolina
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  • Richard Ohrbach
    Affiliations
    Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
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      Abstract

      Although cross-sectional studies of temporomandibular disorder (TMD) often report elevated prevalence in young women, they do not address the risk of its development. Here we evaluate sociodemographic predictors of TMD incidence in a community-based prospective cohort study of U.S. adults. Symptoms and pain-related disability in TMD cases are also described. People aged 18 to 44 years with no history of TMD were enrolled at 4 study sites when they completed questionnaires about sociodemographic characteristics. During the median 2.8-year follow-up period, 2,737 participants completed quarterly screening questionnaires. Those reporting symptoms were examined clinically and 260 had first-onset TMD. Additional questionnaires asked about severity and impact of their symptoms. Univariate and multivariable Cox regression models quantified associations between sociodemographic characteristics and TMD incidence. First-onset TMD developed in 3.9% of participants per annum, typically producing mild to moderate levels of pain and disability in cases. TMD incidence was positively associated with age, whereas females had only slightly greater incidence than males. Compared to whites, Asians had lower TMD incidence whereas African Americans had greater incidence, although the latter was attenuated somewhat after adjusting for satisfaction with socioeconomic circumstances.

      Perspective

      In this study of 18- to 44-year-olds, TMD developed at a higher rate than reported previously for similar age groups. TMD incidence was positively associated with age but weakly associated with gender, thereby differing from demographic patterns of prevalence found in some cross-sectional studies. Experiences related to aging merit investigation as etiologic influences on development of TMD.

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