Prevalence and associated factors of health anxiety in patients with temporomandibular disorders.

OBJECTIVES: To investigate the prevalence and associated factors of health anxiety (HA) in patients with Temporomandibular Disorders (TMDs) using the 8-item Whiteley Index (WI-8) scale. MATERIALS AND METHODS: Three hundred and twenty-nine TMDs patients completed the Visual Analog Scale (VAS), WI-8, Jaw Functional Limitation Scale-8 (JFLS-8), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scales. Clinical examinations were conducted following the Diagnostic Criteria for TMDs Axis I. RESULTS: The prevalence of HA among TMDs patients was 18.54%. Patients with HA had higher scores of VAS-current (p = 0.026), VAS-maximum (p = 0.024), VAS-average (p = 0.030), JFLS-8 (p < 0.001), GAD-7 (p < 0.001) and PHQ-9 (p < 0.001), lower maximum mouth opening (p = 0.016), lower proportion of structure-related TMDs (p = 0.028), and higher proportion of pain-related TMDs (p < 0.001) compared to those without HA. The correlation coefficient was 0.61 (p < 0.001) between WI-8 and GAD-7 and 0.64 (p < 0.001) between WI-8 and PHQ-9. CONCLUSION: Approximately one-fifth of patients with TMDs experienced HA. HA was associated with pain perception, functional limitations, depressive, and anxiety symptoms in individuals with TMDs. HA may contribute to heightened subjective pain experiences rather than structural changes in the TMJ.

Two-phase orthodontic treatment of a patient with a low-angle skeletal class II malocclusion: a 7-year follow-up.

Low-angle skeletal class II malocclusions are often observed with sagittal and vertical developmental abnormalities of the mandible. Two-phase orthodontic treatment of functional orthopedic therapy combined with fixed correction is one of the most common methods to treat of skeletal class II malocclusions. This case report describes the two-phase orthodontic treatment of a patient with severe low-angle skeletal class II malocclusion. A Twin Block orthodontic appliance was used to improve mandibular growth, and the adjustment of the occlusal relationship using a fixed appliance after functional therapy. After treatment, a significant improvement was observed in the patient's facial appearance and occlusal relationship. Additionally, a 7-year follow-up confirmed the stability of the treatment results. Although a vertical facial growth direction is difficult to control, the Twin Block orthodontic appliance in adolescents might effectively improve the difference in the sagittal growth of the mandible. Whilst the growth pattern could not be fully controlled, the treatment significantly improved the patient's facial profile and occlusion.

Chin remodeling in a patient with bimaxillary protrusion and open bite by using mini-implants for temporary anchorage.

Patients with bimaxillary protrusion may have an unattractive profile with a retruded chin contour. Correction of the severely protrusive anterior alveolar bone and teeth combined with a moderate open bite without orthognathic surgery can be challenging. This case report describes the orthodontic treatment of a woman with severe bimaxillary protrusion and a moderate open bite. Excellent chin morphology and facial appearance were obtained with the extraction of 4 first premolars and 4 third molars, and total distalization of both arches with 4 mini-implants, one in each quadrant between the second premolar and the first molar. The total treatment time was 30 months.

Pharyngeal Airway Space and Hyoid Bone Positioning After Different Orthognathic Surgeries in Skeletal Class II Patients.

PURPOSE: To obtain good profiles, patients with severe skeletal Class II malocclusion require orthognathic surgery, which might change their airway space and, hence, influence their quality of sleep. The present study aimed to 1) determine the effect of different orthognathic surgeries on pharyngeal airway space and hyoid bone position in patients with skeletal Class II malocclusion and 2) evaluate the stability of changes in the pharyngeal airway space and hyoid bone position after orthognathic surgeries. MATERIALS AND METHODS: Patients with severe skeletal Class II malocclusion who underwent mandibular advancement (MA) or mandibular advancement and maxillary setback (MAMS) were included in this retrospective cohort study. Changes in the pharyngeal airway space and hyoid bone position were evaluated as the primary outcome variables. Measurements were obtained before surgery (T1), 1 month after surgery (T2), and 2 years after surgery (T3) using Dolphin Imaging Software 11.0. Differences in measurements between T2 and T1 and between T3 and T1 were calculated and imported into SPSS 22.0 for data analysis. RESULTS: Fifty patients were included (25 in MA group and 25 in MAMS group). Oropharyngeal and hypopharyngeal airway cross-dimensions and areas were significantly increased in the MA group (P < .05) and the increases were stable at T3. In the MAMS group, the nasopharyngeal airway cross-dimension and area were decreased (P > .05), but the hypopharyngeal cross-dimension and area were significantly increased (P < .05). The hyoid bone moved superiorly and forward after surgery in the MA group (P < .05), and the movement was stable at T3. CONCLUSIONS: MA can widen the oropharyngeal and hypopharyngeal airway space, and maxillary setback can narrow the nasopharyngeal airway space. Some relapse related to the width of the oropharynx and hypopharynx was found at the long-term observation. The hyoid bone moved superiorly and forward in the MA group.

Anxiety mediates association between sex and jaw function limitation in temporomandibular disorder patients from China.

Aim: The objective of this study is to explore the relationship between sex and jaw function and to test whether anxiety mediates the causal relationship between sex and jaw function in temporomandibular disorders (TMDs) patients. Methods: A total of 488 participants with TMD were included in the analysis. Demographic data were collected. Generalized anxiety symptoms and anxiety severity were initially assessed using the GAD-7 questionnaire. And jaw function limitation was measured using the JFLS-8 scale. A directed acyclic graph (DAG) was used in this study to evaluate the hypotheses. Mediation analysis was conducted to explore causality and to calculate the total effect, natural direct effect (NDE) and natural indirect effect (NIE). Results: In TMD patients, there was a significant association between female and jaw function (r = 0.17, p < 0.001), female and anxiety (r = 0.15, p = 0.002), anxiety and jaw function (r = 0.35, p < 0.001). In addition, sex can directly lead to differences in impaired jaw function (NDE: 3.719, 95% CI: 1.619-5.828, p < 0.001), and can also be causally related to jaw function through anxiety (NIE: 1.146, 95% CI: 0.267-2.024, p = 0.011). And the total effect was 4.865 (95% CI, 2.709-7.029, p < 0.001). Conclusion: A causal mechanism was found that anxiety acts as a mediator of sex effects on jaw function. Therefore, psychological factors need to be taken into account in the treatment of female TMD patients. Further clinical trials are needed to explore whether psychotherapy is more beneficial to improve jaw function in female TMD patients.