Impact of chronic painful temporomandibular disorders on quality of life

Temporomandibular Disorders (TMDs) are pathologies based on multifactorial etiology and a biopsychosocial model, where anxiety becomes one of the most important psychological factors as it is the most frequent symptom presented in most of the population at some point in life. Taking into account the need for a multidisciplinary approach, we set out to evaluate the possible impact of orofacial pain on patients’ quality of life. In this study, the sample population FROM the Medical School of the University of Coimbra (Portugal) was evaluated using two tools: Diagnostic Criteria for Temporomandibular Disorder (DC/TMD) and an adaptation of the West Haven-Yale Multidimensional Pain Inventory. Participants with Chronic Pain for more than three months and diagnosed with TMD were included in the research. The quality of life and pain intensity of participants with Chronic Orofacial Pain were assessed using questionnaires. Subsequently, statistical analysis were conducted. A total sample of 122 participants was selected. A statistically significant association was observed between an increase in pain intensity and a decrease in quality of life in three aspects we considered (daily activity, general mood and anxiety) and we demonstrated that pain intensity is significantly associated with a decrease in quality of life.

Anxiety; Biopsychosocial model; Daily activity; General mood; Oral health-related quality of life; Orofacial pain; Temporomandibular disorders

[1] Macfarlane TV, Glenny A, Worthington HV. Systematic review of population-based epidemiological studies of Oro-facial pain. Journal of Dentistry. 2001; 29: 451–467.

[2] Klasser GD, Bassiur J, de Leeuw R. Differences in reported medical conditions between myogenous and arthrogenous TMD patients and its relevance to the general practitioner. Quintessence International. 2014; 45: 157–167.

[3] Kapos FP, Exposto FG, Oyarzo JF, Durham J. Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. Oral Surgery. 2020; 13: 321–334.

[4] Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical Oral Investigations. 2021; 25: 441–453.

[5] Herrero Babiloni A, Exposto FG, Peck CM, Lindgren BR, Martel MO, Lenglet C, et al. Temporomandibular disorders cases with high-impact pain are more likely to experience short-term pain fluctuations. Scientific Reports. 2022; 12: 1657.

[6] Allison JR, Penlington C, Durham J. DEEP study: utility of the multidimensional pain inventory in persistent Oro-facial pain. Journal of Oral Rehabilitation. 2021; 48: 1210–1218.

[7] Furquim BD, Flamengui LM, Conti PC. TMD and chronic pain: a current view. Dental Press Journal of Orthodontics. 2015; 20: 127–133.

[8] Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. Journal of Dental Research. 2016; 95: 1093–1101.

[9] Alhowimel AS, Alotaibi MA, Alenazi AM, Alqahtani BA, Alshehri MA, Alamam D, et al. Psychosocial predictors of pain and disability outcomes in people with chronic low back pain treated conservatively by guideline-based intervention: a systematic review. Journal of Multidisciplinary Healthcare. 2021; 14: 3549–3559.

[10] Lee KS, Jha N, Kim YJ. Risk factor assessments of temporomandibular disorders via machine learning. Scientific Reports. 2021; 11: 19802.

[11] Karkazi F, Özdemir F. Temporomandibular disorders: fundamental questions and answers. Turkish Journal Of Orthodontics. 2020; 33: 246–252.

[12] Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. Journal of Oral & Facial Pain and Headache. 2014; 28: 6–27.

[13] Gilheaney Ó, Chadwick A. The prevalence and nature of eating and swallowing problems in adults with fibromyalgia: a systematic review. Dysphagia. 2024; 39: 92–108.

[14] Cruz KLT, Santos ICS, de Jesus Alves de Baptista CR, Mattiello-Sverzut AC. Quality of life assessment instruments in children and adolescents with neuromuscular diseases: a systematic scoping review. Health and Quality of Life Outcomes. 2024; 22: 18.

[15] Baniasadi K, Armoon B, Higgs P, Bayat A, Mohammadi Gharehghani MA, Hemmat M, et al. The association of oral health status and socio-economic determinants with oral health-related quality of life among the elderly: a systematic review and meta-analysis. International Journal of Dental Hygiene. 2021; 19: 153–165.

[16] Durham J, Steele JG, Wassell RW, Exley C. Living with uncertainty: temporomandibular disorders. Journal of Dental Research. 2010; 89: 827–830.

[17] Dos Santos EA, Peinado BRR, Frazão DR, Né YGS, Fagundes NCF, Magno MB, et al. Association between temporomandibular disorders and anxiety: a systematic review. Frontiers in Psychiatry. 2022; 13: 990430.

[18] Resende CM, Alves AC, Coelho LT, Alchieri JC, Roncalli AG, Barbosa GA. Quality of life and general health in patients with temporomandibular disorders. Brazilian Oral Research. 2013; 27: 116–121.

[19] Hekmati A, Mortazavi N, Ozouni-Davaji RB, Vakili M. Personality traits and anxiety in patients with temporomandibular disorders. BMC Psychology. 2022; 10: 86.

[20] Kerns RD, Turk DC, Rudy TE. The west haven-yale multidimensional pain inventory (WHYMPI) pain. 1985; 23: 345–356.

[21] Kuhlmann EH, Tallman BA. The impact of nurses’ beliefs, attitudes, and cultural sensitivity on the management of patient pain. Journal of Transcultural Nursing. 2022; 33: 624–631.

[22] Ning W, Schmalz G, Li P, Huang S. Oral health‐related quality of life in patients with osteoarthritis of the temporomandibular joint—results of a systematic review. Journal of Oral Rehabilitation. 2022; 49: 1106–1114.

[23] Aranha RLB, Martins RC, de Aguilar DR, Moreno-Drada JA, Sohn W, Martins CC, et al. Association between stress at work and temporomandibular disorders: a systematic review. BioMed Research International. 2021; 2021: 2055513.

[24] Han W, Kwon S, Lee Y, Park C, Jang E. The associations between work-related factors and temporomandibular disorders among female full-time employees: findings from the Fourth Korea National Health and Nutrition Examination Survey IV (2007–2009). Annals of Occupational and Environmental Medicine. 2018; 30: 42.

[25] Adams G, Salomons TV. Attending work with chronic pain is associated with higher levels of psychosocial stress. Canadian Journal of Pain. 2021; 5: 107–116.

[26] Lima RB, Buarque A. Oral health in the context of prevention of absenteeism and presenteeism in the workplace. Revista Brasileira de Medicina do Trabalho. 2019; 17: 594–604.

[27] Svebak S, Halvari H. Sickness absence due to chronic musculoskeletal pain: the exploration of a predictive psychological model including negative moods, subjective health and work efficacy in an adult county population (The HUNT Study). Europe’s Journal of Psychology. 2018; 14: 373–385.

[28] Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R, et al. Psychological factors associated with development of TMD: the OPPERA prospective cohort study. The Journal of Pain. 2013; 14: T75–T90.

[29] Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful temporomandibular disorder: decade of discovery from OPPERA studies. Journal of Dental Research. 2016; 95: 1084–1092.

[30] Slade GD, Bair E, By K, Mulkey F, Baraian C, Rothwell R, et al. Study methods, recruitment, sociodemographic findings, and demographic representativeness in the OPPERA study. The Journal of Pain. 2011; 12: T12–T26.

[31] Maracci LM, Rodrigues AS, Knorst JK, Salbego RS, Ferrazzo VA, Liedke GS, et al. Does marital status influence TMD-related chronic pain? A cross-sectional study. Journal of Bodywork and Movement Therapies. 2022; 29: 112–116.

[32] Taylor SS, Davis MC, Zautra AJ. Relationship status and quality moderate daily pain-related changes in physical disability, affect, and cognitions in women with chronic pain. Pain. 2013; 154: 147–153.

[33] Resende CMBM, Rocha LGDDS, Paiva RPD, Cavalcanti CDS, Almeida EO, Roncalli AG, et al. Relationship between anxiety, quality of life, and sociodemographic characteristics and temporomandibular disorder. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2020; 129: 125–132.

[34] Kmeid E, Nacouzi M, Hallit S, Rohayem Z. Prevalence of temporomandibular joint disorder in the Lebanese population, and its association with depression, anxiety, and stress. Head & Face Medicine. 2020; 16: 19.

[35] Reis PHF, Laxe LAC, Lacerda-Santos R, Münchow EA. Distribution of anxiety and depression among different subtypes of temporomandibular disorder: a systematic review and meta-analysis. Journal of Oral Rehabilitation. 2022; 49: 754–767.

[36] Biondi M, Valentini M. Relaxation treatments and biofeedback for anxiety and somatic stress-related disorders. Rivista di Psichiatria. 2014; 49: 217–226. (In Italian)

[37] Rothwell PS. Personality and temporomandibular joint dysfunction. Oral Surgery, Oral Medicine, Oral Pathology. 1972; 34: 734–742.

[38] Mongini F, Rota E, Evangelista A, Ciccone G, Milani C, Ugolini A, et al. Personality profiles and subjective perception of pain in head pain patients. Pain. 2009; 144: 125–129.

[39] Ferrando M, Andreu Y, José Galdón M, Durá E, Poveda R, Vincente Bagán J. Psychological variables and temporomandibular disorders: distress, coping, and personality. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2004; 98: 153–160.

[40] Yap A, Marpaung C. Psychological factors in temporomandibular disorders and somatization: a multidimensional analysis of personality, coping, and distress among young adults. To be published in The International Journal of Prosthodontics. 2023. [Preprint].

[41] Naylor B, Boag S, Gustin SM. New evidence for a pain personality? A critical review of the last 120 years of pain and personality. Scandinavian Journal of Pain. 2017; 17: 58–67.

[42] Hekmati A, Mortazavi N, Ozouni-Davaji RB, Vakili M. Personality traits and anxiety in patients with temporomandibular disorders. BMC Psychology. 2022; 10: 86.

[43] Pereira MG, Carvalho C, Costa ECV, Leite Â, Almeida V. Quality of life in chronic pain patients: illness- and wellness-focused coping as moderators. PsyCh Journal. 2021; 10: 283–294.

[44] Pincus T, Morley S. Cognitive-processing bias in chronic pain: a review and integration. Psychological Bulletin. 2001; 127: 599–617.

[45] Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. British Journal of Anaesthesia. 2013; 111: 52–58.

[46] Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. The Journal of Pain. 2009; 10: 447–485.