The Physical Symptom Scale-8: Psychometric Characteristics of a Short-Form Version of the PHQ-15 and its Use in TMD-Related Assessment and Research.

AIMS: To describe the development of the Physical Symptom Scale-8 (PSS-8) and to examine its psychometric properties and use in temporomandibular disorder (TMD)-related assessment and research. METHODS: An online survey comprising demographic variables, the DC/TMD pain screener (TPS), Short-Form Fonseca Anamnestic Index (SFAI), PSS-8, PHQ-15, and Depression, Anxiety, and Stress Scale-21 (DASS-21) was administered to young adults attending a technical college. The PSS-8 adopted the Somatic Symptom Scale-8 (SSS-8) items but maintained the 3-point response scale and 4-week time frame of the PHQ-15. Internal consistency and reliability of the PSS-8 were determined by its Cronbach α value. Known-groups and concurrent/convergent validity were examined using Mann-Whitney U test and Spearman correlation (α = .05), respectively. RESULTS: Responses from 400 participants (mean age 18.8 ± 1.5 years; 52.3% women) were evaluated. Pain-related (WPT) and all (WAT) TMDs were present in 8.5% and 17.3% of the sample, respectively. The PSS-8 exhibited good internal consistency (α = 0.82) and sound known-groups validity, with the WPT/WAT groups having significantly higher PSS-8 scores than those without TMDs. Good concurrent and convergent validity were also observed, with moderate to strong correlations with the PHQ-15 (rs = 0.97) and DASS-21 scores (rs = 0.48 to 0.60). Correlations with the TPS and SFAI scores were weaker (rs = 0.28 to 0.34). CONCLUSION: The PSS-8 presented good psychometric properties and performed similarly to the PHQ-15. It holds promise as the "de facto" shortened version of the PHQ-15 for TMDs and related work.

Painful temporomandibular disorders in Confucian-heritage cultures: Their inter-relationship with bodily pain, psychological well-being and distress.

BACKGROUND: Temporomandibular disorders (TMDs) are common and affect individuals negatively. OBJECTIVES: This study investigated the inter-relationship of painful TMDs with bodily pain, psychological well-being and distress in young people from a Confucian-heritage culture (CHC). METHODS: Adolescents/young adults were recruited from a polytechnic in Singapore. While the presence/severity of painful TMDs and bodily pain were established with the DC/TMD Pain Screener (TPS) and Maciel's Pain Inventory, psychological well-being and distress were evaluated with the Scales of Psychological Well-being-18 (SPWB-18) and Patient Health Questionnaire-4 (PHQ-4). Statistical explorations were conducted using chi-square/Mann-Whitney U tests, Spearman's correlation and logistic regression analyses (α = .05). RESULTS: Among the 225 participants (mean age 20.1 ± 3.9 years) examined, 11.6% had painful TMDs and 68.9% experienced multisite bodily pain. Though painful TMDs were accompanied by a higher occurrence of multisite bodily pain, the overall/discrete number of bodily pain sites did not differ substantially between the 'no TMD pain' (NT) and 'with TMD pain' (WT) groups. Besides ear pain, differences in overall/discrete bodily pain scores were also insignificant. However, significant differences in environmental mastery, overall psychological distress, depression and anxiety subscale scores were discerned between the NT and WT groups. Psychological well-being and distress were moderately and negatively correlated (rs = -.56). Multivariate analysis indicated that ear pain and psychological distress increased the prospect of painful TMDs. CONCLUSION: The prevalence of multi-site bodily pain was high in young people from CHCs irrespective of the painful TMDs' presence of painful TMDs. Enhancing environmental mastery and relieving depression/anxiety may help manage TMD pain.

Temporomandibular disorder, otologic, body pain, and psychological symptoms: Their inter-relationships in Asian youths.

PURPOSE: This study aimed to establish the inter-relationships between Temporomandibular disorders (TMDs), otologic, pain, and psychological comorbidities in Asian youths. METHODS: Youths, aged 17 to 24 years old, were enrolled from a local polytechnic and an electronic survey encompassing demographic variables, the DC/TMD TMD pain screener (TPS), Short-form Fonseca Anamnestic Index (SFAI), modified Maciel's Otologic/Pain Symptom Inventory, and Patient Health Questionnaire-4 was administered. Participants were subsequently categorized into "no TMD pain (NP)" and "with TMD pain (WP)" in addition to "no TMDs (NT)" and "with any TMDs (WT)" groups. Data were evaluated with the Chi-square test, non-parametric, and logistic regression analyses (α = 0.05). RESULTS: Among the 198 participants (mean age 18.8 ± 1.7 years), 11.1% had painful TMDs and 18.2% experienced TMD pain and/or dysfunction. Significant differences in total-otologic symptom (total-OS), vertigo, and dizziness plus otalgia, tinnitus, and hearing loss scores were observed between the WP-NP and WT-NT groups correspondingly. While total-comorbid pain (total-CP) and psychological distress (total-PD) scores varied substantially between the WT-NT group, only a significant difference in total-PD scores was discerned between the WP-NP group. Total-OS scores were moderately correlated to TPS/SFAI, total-CP, total-PD scores. and psychological distress was a risk factor for painful TMDs. CONCLUSION: Otologic and pain comorbidities were prevalent among Asian youths with TMDs and appear to be interrelated. The complex interaction of TMDs with otological, pain, and psychological comorbidities must be considered when caring for youths with multiple somatic complaints. Int J Prosthodont 2023. doi: 10.11607/ijp.8451.

Use of the Depression Anxiety Stress Scale-21 in young people with temporomandibular disorders: Reliability and dimensionality.

OBJECTIVE: The reliability and dimensionality of the Depression Anxiety Stress Scale-21 (DASS-21) were explored in adolescents/young adults with temporomandibular disorders (TMDs). METHODS: TMD presence was established with the Fonseca Anamnestic Index. Reliability of the DASS-21 for participants with (WT) and without (NT) TMDs was assessed by the Cronbach alpha test, while dimensionality was examined using exploratory factor analysis. RESULTS: Data from 400 participants (mean age 18.8 ± 1.5 years; 52.2% women) comprising 47.0% with and 53.0% without TMDs were evaluated. Total-DASS and the 3 subscales showed acceptable to high internal consistencies for the WT and NT groups, with alphas of 0.78-0.94 and 0.66-0.92, respectively. Although 3 factors contributed to about half the variance for both groups, scalar and item discrepancies in the primary anxiety-stress factor existed. CONCLUSION: The DASS-21 has good reliability but may comprise only 2 dimensions, specifically anxiety-stress and depression, instead of the 3 originally asserted.

Dental environment and practitioner preferences of southeast Asian youths with dental fear/anxiety.

OBJECTIVES: This study estimated the prevalence of dental fear/anxiety (DFA) in Southeast Asian youths and established their dental environment and practitioner preferences. METHODS: A convenience sample of youths were enrolled from a local polytechnic. The Index of Dental Anxiety and Fear (IDAF-4C) was used to ascertain the presence and severity of DFA. Socio-demographic and IDAF-4C data, along with participants' dental environment and practitioner partialities were gathered electronically. Statistical evaluations were performed with Kruskal-Wallis and Chi-square tests (α = 0.05). RESULTS: Data from a total of 215 participants were appraised. The mean age of the study sample was 18.9 ± 2.0 years (87.4% women). Of these, 12.6% had moderate-to-high DFA and 6.0% had high-to-extreme DFA. As a group, Southeast Asian youths generally liked dental clinics with adorned walls, cooler temperatures, magazines/books, background music and audio-visual devices. In addition, they favoured female practitioners who are younger (≤45 years old), friendly, talkative and maintain a professional relationship. However, those with high-to-extreme DFA preferred a warmer clinic environment and to have an informal relationship with their dental practitioners (p = 0.01). CONCLUSIONS: The prevalence of moderate-to-extreme DFA in Southeast Asian youths was 18.6%. Individuals with high-to-extreme DFA may have disparate dental environment and practitioner preferences compared to those with no-to-moderate DFA.

Negative affectivity and emotions in youths with temporomandibular disorders across cultures.

OBJECTIVE: The relationships between temporomandibular disorders (TMDs) and negative affectivity/emotions across cultures and the emotional predictors for TMDs in Southeast Asian youths were investigated. METHODS: The presence of TMDs and negative affectivity/emotions were determined with the Fonseca Anamnestic Index (FAI) and Depression, Anxiety, Stress Scales-21 (DASS-21). Statistical evaluations were done with non-parametric and logistic regression analyses (α. RESULTS: The total sample comprised 400 Singaporean and 501 Indonesian youths (mean age 19.30 ± 1.48 years; 65.0% women) of whom 47.0% and 59.3% had mild-to-severe TMDs, respectively. For both cultures, participants with TMDs had significantly greater negative affectivity, depression, anxiety, and stress than those with no TMDs. Indonesian youths also presented higher levels of emotional distress than their Singaporean counterparts. Correlations between FAI and anxiety/stress scores were moderately strong. CONCLUSION: Cultural variations can influence the expression of TMDs and emotional distress. Being female and anxious increased the risk of TMDs.

Association of temporomandibular disorders severity with otologic and concomitant pain symptoms in Asian youths.

OBJECTIVE: To investigate the presence/severity of TMDs among Asian youths and examine the associations between TMD severity, otologic, and concomitant pain symptoms. METHODS: Youths (17-24 years old) were recruited from a local polytechnic. The presence/severity of TMDs was determined with the Fonseca Anamnestic Index (FAI), while otologic/concomitant pain symptoms were appraised with the Maciel's Symptoms Checklist (MSC). Demographic, FAI, and MSC data were evaluated using Kruskal Wallis, chi-square, and relevant post-hoc tests (α = 0.05). RESULTS: Among the participants (n = 200) enrolled, 40.5% had no TMD, whereas mild, moderate, and severe TMD were present in 43.5%, 12.5%, and 3.5%, respectively. Participants with moderate/severe TMDs had significantly more otalgia, tinnitus, vertigo, dizziness, ear pruritus, hearing loss, ear fullness, headache, eye, neck, and back pain than those with no TMDs (p < 0.001). CONCLUSION: Otologic and concomitant pain symptoms were associated with TMDs and appear to increase with progressive TMD severity.

Dental fear and anxiety in Asian youths: response components and inducing stimuli.

OBJECTIVES: This study estimated the prevalence of dental fear/anxiety (DFA) and phobia in Asian youths and investigated the fear/anxiety response components and triggers for those with DFA. MATERIALS AND METHODS: A convenience sample of youths, aged 17 to 24 years old, was recruited from a local polytechnic. The Index of Dental Anxiety and Fear-4C + (IDAF-4C +) was employed to assess the occurrence of DFA (IDAF-4C) and phobia (IDAF-P) as well as to ascertain fear/anxiety-inducing stimuli (IDAF-S). Psychological distress was determined with the Patient Health Questionnaire-4 (PHQ-4). Sociodemographic, IDAF-4C + , dental attendance patterns, and PHQ-4 data were gathered electronically. Statistical analyses were conducted with chi-square, Kruskal-Wallis, and relevant post hoc tests (α = 0.05). RESULTS: A total of 215 participants were enrolled (mean age of 18.9 ± 2.0 years; 87.4% women). Of these, 12.6/6.0% had moderate-to-high (MH)/high-to-extreme (HE) DFA and 0.9% experienced dental phobia. Significant differences in scores were observed between the HE/MH and no-to-moderate (NM) groups for all IDAF-4C components. Apart from the cost of dental treatment, IDAF-4S scores varied significantly among the three DFA groups. The two most highly rated DFA stimuli were painful/uncomfortable procedures and needles/injections for the HE group, while they were needles/injections and the cost of dental treatment for the MH and NM groups. CONCLUSIONS: Moderate-to-extreme DFA existed in 18.6% of the Asian youths examined. The emotional and physiological components of the IDAF-4C appear to contribute more to the DFA response. Dental pain including needles/injections and the cost of dental treatment troubled Asian youths the most. CLINICAL RELEVANCE: DFA is a common problem among Asian youths, and understanding its extent, nature, and triggers is central for effective interventions.