The potential association between sedentary behaviors and risk of temporomandibular disorders: evidence from Mendelian randomization analysis

The role of sedentary behaviors in temporomandibular disorders (TMD) has not been thoroughly investigated. This study aims to investigate the potential association between sedentary behaviors and TMD using Mendelian randomization (MR) analysis. The MR method was employed to assess the causal association between sedentary behaviors and the risk of TMD. Genetic variants associated with sedentary behaviors, such as watching TV (Television), using computers and driving, were used as instrumental variables (IVs). MR analysis was performed using inverse variance-weighted (IVW) and weighted median methods, alongside MR-Egger regression to assess pleiotropy and statistical heterogeneity. Furthermore, leave-one-out analyses were conducted to assess whether any single SNP (single nucleotide polymorphism) or subset of SNPs influenced the results. Our analysis identified a significant association between driving time and the risk of temporomandibular disorders (IVW: OR (Odd ratio) = 2.797, 95% CI (Confidence interval) = 1.148–6.811, p = 0.024; weighted median OR = 4.271, 95% CI = 1.226–14.871, p = 0.023). In contrast, no significant associations were observed between time spent watching TV and using a computer and TMD risk. The robustness of the findings was confirmed through sensitivity analyses, including leave-one-out analysis. This study provides evidence of a potential genetic link between prolonged driving and TMD risk, suggesting that individuals frequently engaged in long-duration driving should be monitored for TMD symptoms. Further research is warranted to explore the complex interactions between sedentary behaviors and TMD, incorporating longitudinal and comprehensive assessments.

Sedentary behaviors; Temporomandibular disorders; Mendelian randomization

[1] Ahmad M, Schiffman EL. Temporomandibular joint disorders and orofacial pain. Dental Clinics of North America. 2016; 60: 105–124.

[2] Li DTS, Leung YY. Temporomandibular disorders: current concepts and controversies in diagnosis and management. Diagnostics. 2021; 11: 459.

[3] Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. American Family Physician. 2015; 91: 378–386.

[4] Wadhokar OC, Patil DS. Current trends in the management of temporomandibular joint dysfunction: a review. Cureus. 2022; 14: e29314.

[5] Karamat A, Smith JG, Melek LNF, Renton T. Psychologic impact of chronic orofacial pain: a critical review. Journal of Oral & Facial Pain and Headache. 2022; 36: 103–140.

[6] van de Vegte YJ, Said MA, Rienstra M, van der Harst P, Verweij N. Genome-wide association studies and Mendelian randomization analyses for leisure sedentary behaviours. Nature Communications. 2020; 11: 1770.

[7] Zhao X, Yang Y, Yue R, Su C. Potential causal association betAween leisure sedentary behaviors, physical activity and musculoskeletal health: a Mendelian randomization study. PLOS ONE. 2023; 18: e0283014.

[8] Zhou J, Tang R, Wang X, Ma H, Li X, Heianza Y, et al. Frailty status, sedentary behaviors, and risk of incident bone fractures. The Journals of Gerontology. Series A, Biological sciences and Medical Sciences. 2024; 79: glae186.

[9] Heron L, O’Neill C, McAneney H, Kee F, Tully MA. Direct healthcare costs of sedentary behaviour in the UK. Journal of Epidemiology and Community Health. 2019; 73: 625–629.

[10] Thomas DC, Singer SR, Markman S. Temporomandibular disorders and dental occlusion: what do we know so far? Dental Clinics of North America. 2023; 67: 299–308.

[11] Namvar MA, Afkari BF, Moslemkhani C, Mansoori K, Dadashi M. The relationship between depression and anxiety with temporomandibular disorder symptoms in dental students. Maedica. 2021; 16: 590–594.

[12] Yıldız NT, Kocaman H, Bingöl H. Validity and reliability of the Turkish version of the oral behaviors checklist. Oral Diseases. 2024; 30: 4014–4023.

[13] Cao Z, Li Q, Li Y, Wu J. Causal association of leisure sedentary behavior with arthritis: a Mendelian randomization analysis. Seminars in Arthritis and Rheumatism. 2023; 59: 152171.

[14] 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.

[15] Chen X, Xu J, Cheng Z, Wang Q, Zhao Z, Jiang Q. Causal relationship between hypothyroidism and temporomandibular disorders: evidence from complementary genetic methods. BMC Oral Health. 2024; 24: 247.

[16] Chen X, Cheng Z, Xu J, Wang Q, Zhao Z, Jiang Q. Causal effects of autoimmune diseases on temporomandibular disorders and the mediating pathways: a Mendelian randomization study. Frontiers in Immunology. 2024; 15: 1390516.

[17] Que H, Zhang Q, Xu S, Chu T, Xu L, Wang Y. Bi-directional two-sample Mendelian randomization identifies causal association of depression with temporomandibular disorders. Journal of Oral Rehabilitation. 2024; 51: 1653–1661.

[18] Xiang Y, Song J, Liang Y, Sun J, Zheng Z. Causal relationship between psychiatric traits and temporomandibular disorders: a bidirectional two-sample Mendelian randomization study. Clinical Oral Investigations. 2023; 27: 7513–7521.

[19] Xu C, Ren X, Lin P, Jin S, Zhang Z. Exploring the causal effects of sleep characteristics on TMD-related pain: a two-sample Mendelian randomization study. Clinical Oral Investigations. 2024; 28: 384.

[20] Chaves TC, Turci AM, Pinheiro CF, Sousa LM, Grossi DB. Static body postural misalignment in individuals with temporomandibular disorders: a systematic review. Brazilian Journal of Physical Therapy. 2014; 18: 481–501.

[21] Cortese S, Mondello A, Galarza R, Biondi A. Postural alterations as a risk factor for temporomandibular disorders. Acta Odontologica Latinoamericana. 2017; 30: 57–61.

[22] Cuccia A, Caradonna C. The relationship between the stomatognathic system and body posture. Clinics. 2009; 64: 61–66.

[23] Dzakpasu FQS, Carver A, Brakenridge CJ, Cicuttini F, Urquhart DM, Owen N, et al. Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2021; 18: 159.

[24] Elmesmari R, Reilly JJ, Martin A, Paton JY. Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: a systematic review and meta-analysis. PLOS ONE. 2017; 12: e0179429.

[25] Gregory WJ, Saygin D. Assessment of physical activity and muscle function in adult inflammatory myopathies. Current Rheumatology Reports. 2022; 24: 54–63.

[26] Stephenson ML, Ostrander AG, Norasi H, Dorneich MC. Shoulder muscular fatigue from static posture concurrently reduces cognitive attentional resources. Human Factors. 2020; 62: 589–602.

[27] Bruno Bordoni, Matthew Varacallo. Anatomy, Head and Neck, Temporomandibular Joint. StatPearls: Treasure Island (FL). 2024.

[28] Fougeront N, Fleiter B. Temporomandibular disorder and comorbid neck pain: facts and hypotheses regarding pain-induced and rehabilitation-induced motor activity changes. Canadian Journal of Physiology and Pharmacology. 2018; 96: 1051–1059.

[29] Shu J, Wang Q, Ma H, Teng H, Zheng T, Liu Z. Biomechanical study on the changes of stress in temporomandibular joints after the orthognathic surgery in patients with mandibular prognathism: a 3D finite element study. Acta of Bioengineering and Biomechanics. 2020; 22: 155–163.

[30] Dutra Dias H, Botelho AL, Bortoloti R, Dos Reis AC. Neuroscience contributes to the understanding of the neurobiology of temporomandibular disorders associated with stress and anxiety. CRANIO®. 2024; 42: 439–444.

[31] Romero-Reyes M, Bassiur JP. Temporomandibular disorders, bruxism and headaches. Neurologic Clinics. 2024; 42: 573–584.

[32] Clark BK, Healy GN, Winkler EA, Gardiner PA, Sugiyama T, Dunstan DW, et al. Relationship of television time with accelerometer-derived sedentary time: NHANES. Medicine & Science in Sports & Exercise. 2011; 43: 822–828.

[33] Chaves PJ, de Oliveira FEM, Damázio LCM. Incidence of postural changes and temporomandibular disorders in students. Acta Ortopedica Brasileira. 2017; 25: 162–164.

[34] Woźniak K, Lipski M, Lichota D, Szyszka-Sommerfeld L. Muscle fatigue in the temporal and masseter muscles in patients with temporomandibular dysfunction. BioMed Research International. 2015; 2015: 269734.