Background & Aims

Temporomandibular disorders (TMD) include chronic pain and functional jaw disturbances in the orofacial area. As with other chronic pain conditions, individuals with TMD often report comorbidities such as increased levels of stress, anxiety, and depression that together cause a negative impact on quality of life. In addition, when compared to men, women not only report more frequent symptoms of TMD, but also more severe symptoms. From a clinical perspective, the majority of these patients are managed primarily in dentistry and general dentists meet patients with TMD on a regular basis. Even so, dentists report uncertainties in their clinical decision-making for these patients. One of the challenges reported is the assessment of factors that affect the long-term prognosis. Therefore, our aim was to explore the individual longitudinal fluctuations in TMD, overall and stratified by gender, in a population-based sample of Swedish adults attending routine dental check-ups.

Methods

This study was undertaken in the county of Västerbotten, Northern Sweden 2010–2017. Individuals aged 18-72 were eligible for inclusion if they underwent at least two routine dental check-ups, and completed a digital health history that included answers to three screening questions for TMD (3Q/TMD):
Q1: Do you have pain in your temple, face, jaw, or jaw joint, once a week or more?
Q2: Do you have pain when you open your mouth or chew once a week or more?
Q3: Does your jaw lock or become stuck once a week or more?
All questions are answered with “yes” or “no”. Affirmative answer to Q1 and/or Q2 was categorized as “TMD pain”, whereas an affirmative answer to Q3 was categorized as “functional jaw disturbances”. A Markov multistate model was used to analyze time to events, where individuals report multiple events or states over time. In addition, the probability of all possible transitions between the states within a time span of one year was estimated, along with 95% confidence inter

Results

In total, 94,771 individuals were included in the analysis (49.9% women), with a total of 205,690 available repeated visits. The number of visits were equally distributed between women and men.
In total, 9,008 state transitions were recorded over the 8-year period. The two most common state transitions were from “no TMD” to “TMD pain only”, followed by the transition from “no TMD” to “functional jaw disturbances only”, respectively. Transitions from states with pain and functional jaw disturbances into states with no TMD or concurrent TMD pain and functional jaw disturbances were less frequent.
Compared to men, women had a lower rate of transitions from “TMD pain only” to “no TMD”, (HR: 0.83, CI: 0.75 – 0.91), and higher rate of transitions from “functional jaw disturbances only” into “concurrent TMD pain and functional jaw disturbances” (HR:1.62, CI:1.15-2.30).

Conclusions

The findings from this longitudinal population-based study of Swedish adults attending routine dental check-ups showed that women experience transitions from no TMD to both TMD pain and functional jaw disturbances more frequently than men. Furthermore, over a period of one year, men tend to recover more often as compared to women, especially in relation to TMD pain alone.

References

E. Keogh, “Sex and gender differences in pain: past, present, and future,” Pain, vol. 163, no. Suppl 1, pp. S108-S116, Nov 1 2022, doi: 10.1097/j.pain.0000000000002738.

B. Haggman-Henrikson et al., “Increasing gender differences in the prevalence and chronification of orofacial pain in the population,” Pain, vol. 161, no. 8, pp. 1768-1775, Aug 2020, doi: 10.1097/j.pain.0000000000001872.

E. L. Schiffman et al., “Longitudinal Stability of Common TMJ Structural Disorders,” J. Dent. Res., vol. 96, no. 3, pp. 270-276, Mar 2017, doi: 10.1177/0022034516679396.

A. Lovgren, C. M. Visscher, B. Haggman-Henrikson, F. Lobbezoo, S. Marklund, and A. Wanman, “Validity of three screening questions (3Q/TMD) in relation to the DC/TMD,” J. Oral Rehabil., vol. 43, no. 10, pp. 729-36, Oct 2016, doi: 10.1111/joor.12428.

Presenting Author

Anna Lövgren

Poster Authors

Anna Lövgren

DDS, PhD

Umeå University

Lead Author

Simon Vallin

MSc

Faculty of Medicine, Dep. of Odontology/Clinical Oral Physiology, Umeå University, Umeå, Sweden

Lead Author

Birgitta Häggman-Henrikson

Malmö University

Lead Author

Corine Visscher

Lead Author

Christopher Peck

DDS

National University Health System

Lead Author

Flavia Penteado Kapos

Duke University

Lead Author

Per Liv

Lead Author

Topics

  • Epidemiology