Background & Aims

Temporomandibular disorders (TMD) are a group of compex disorders that require a biopsychosocial approach to diagnosis and treatment. Painful TMD, such as myalgia and arthralgia, are biopsychosocial in nature and are interconnected with general health. The development of painful TMD may be influenced by an individual’s psychological profile and a state of pain amplification. Recent literature supports the need for a biopsychosocial assessment that includes validated diagnostic instruments and primarily conservative multidisciplinary management strategies. This study aimed to evaluate the differences between biopsychosocial subtypes based on Axis II Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in patients with painful TMD before and after two conservative treatment approaches: Home Therapeutic Exercises (HTE) alone, and HTE + Occlusal Stabilization Splint (OSS).

Methods

A randomized clinical trial was conducted with 64 patients with painful TMD, divided into two parallel arms. Group 1 (n=47), test group, received an occlusal stabilization splint and home therapeutic exercises, while Group 2 (n=17),control group, performed only home therapeutic exercises. The study assessed three variables: chronic pain intensity (rated from 0 to 4), depression level (normal, moderate, and severe), and physical symptoms (normal, moderate, and severe). Patients completed the RDC/TMD questionnaire to evaluate axis I and II biopsychosocial subtypes before (time I: baseline) and after (time II: 12 weeks follow-up) the interventions.

Results

The study used the Mann-Whitney U test to compare two independent groups and the Wilcoxon signed-rank test to compare pre- and post-intervention data within the same group. Fisher’s exact test was used to assess the association between gender and group. There were no statistically significant differences between the groups at the 5% significance level (p-values> 0.05).

In the test group, significant differences were found in three variables (p-values <0.0001) when comparing before and after the intervention, with post-intervention scores consistently lower. The occurrence of severe grades of physical symptoms and depression decreased, while the occurrence of normal grades increased. Chronic pain improved with grade 0 (no pain in the last 6 months) increasing from 23% to 75%, and grade 1 (low pain intensity) and 2 (high pain intensity) decreasing from 21% to 6% and from 45% to 19%, respectively.

No significant difference was observed between the groups pre-intervention. Post-intervention, a statistically significant difference was observed in chronic pain (p-value 0.0097), with a lower percentage of grade 0, and a higher total percentage of grades above 0. Additionally, a statistically significant difference was observed in physical symptoms (p-value 0.0256) between test and control groups, with the control group exhibiting higher pain and symptom scores with a higher percentage of moderate and a lower percentage of normal. There was no significant difference in depression between pre and post-intervention.

Conclusions

After the application of occlusal stabilization splint and home therapeutic exercises, the degree of chronic pain and physical symptoms related to TMD variables was reduced. However, no significant change was observed in the degree of depression. It is essential to conduct biopsychosocial screening during TMD pain assessment since patients have varied biopsychosocial profiles.

References

Chisnoiu, A. M., Picos, A. M., Popa, S., Chisnoiu, P. D., Lascu, L., Picos, A., & Chisnoiu, R. (2015). Factors involved in the etiology of temporomandibular disorders – a literature review. Clujul medical (1957), 88(4), 473–478. https://doi.org/10.15386/cjmed-485 Suvinen, T. I., Reade, P. C., Kemppainen, P., Könönen, M., & Dworkin, S. F. (2005). Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. European journal of pain (London, England), 9(6), 613–633. https://doi.org/10.1016/j.ejpain.2005.01.012 Kapos, F.P., Exposto, F.G., Oyarzo, J.F. and Durham, J. (2020), Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. Oral Surg, 13: 321-334. https://doi.org/10.1111/ors.12473 Slade, G. D., Fillingim, R. B., Sanders, A. E., Bair, E., Greenspan, J. D., Ohrbach, R., Dubner, R., Diatchenko, L., Smith, S. B., Knott, C., & Maixner, W. (2013). Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: implications and future directions. The journal of pain, 14(12 Suppl), T116–T124. https://doi.org/10.1016/j.jpain.2013.09.010

Presenting Author

Juliana de Oliveira

Poster Authors

Juliana de Oliveira

DDS and Master's Student

UNIVERSITY OF SÃO PAULO (USP)

Lead Author

E-mail

Simone OLIVEIRA

FLUMINENSE FEDERAL UNIVERSITY

Lead Author

E-mail

Julyana Zagury

Rutgers School of Dental Medicine

Lead Author

E-mail

Newton Sesma

PhD

University of São Paulo

Lead Author

E-mail

Dalva Lagana

PhD

University of São Paulo

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial

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