The continuous adverse impact of COVID-19 on temporomandibular disorders and bruxism: comparison of pre- during- and post-pandemic time periods.

INTRODUCTION: Some of the conditions affected by the COVID-19 pandemic were Temporomandibular Disorders (TMD) and bruxism. The present study compares the effect of the pandemic on TMD and bruxism (sleep and awake) in three time periods: before the pandemic (pre-COV), during the pandemic (during-COV) and after the pandemic subsided (post-COVR). MATERIAL AND METHODS: A total of 587 adult patients (108 in the pre-COV group, 180 in the during-COV group and 252 in the post-COVR group) who arrived for a routine dental treatment between October 2018 and January 2023 were evaluated according to Axis I diagnosis of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Each patient received a DC/TMD Axis I diagnosis as follows: (i) Painful TMD (defined by the presence of at least one of the following - local myalgia, myofascial pain with referral, arthralgia or headache attributed to TMD); (ii) Non painful TMD (defined by the presence of disc displacement with/without reduction, degenerative joint disorders and/or dislocation), (iii) Possible sleep bruxism (SB) and/or (iv) Possible awake bruxism (AB). STATISTICAL METHODS: Logistic regression analyses were conducted to establish the impact of time and gender on the prospects of painful TMD, non-painful TMD, SB and AB. RESULTS: The odds of subjects to be diagnosed with painful TMD at the post-COVR era were 3.3 times higher compared to the pre-pandemic time period (pre-COV, 95% C.I. 1.438-7.585). The odds of subjects to be diagnosed with non-painful TMD during-COV were 4 times higher compared to the pre-COV era (95% C.I. 1.332-12.542). The odds of subjects to present possible SB at post-COVR were 2.7 times higher compared to pre-pandemic (pre-COV, 95% C.I. 1.258-5.889, p < 0.05) and the odds to present possible AB after the pandemic subsided (post-COVR) were 3.2 times compared to the pre-pandemic period (95% C.I. 1.496-6.949). The odds of female subjects to be diagnosed with either painful or non-painful TMD were 3.7-4.4 times higher, compared to males. CONCLUSIONS: Results indicate that with regard to TMD and bruxism the pandemic adverse effects persist also after COVID-19 subsides and the restrictions caused by it are abolished. Apparently, during the pandemic females were affected more seriously by painful and non-painful TMD than males.

Temporomandibular Disorders and Bruxism among Sex Workers-A Cross Sectional Study.

Sex workers are a highly underprivileged population which is present all around the world. Sex work is associated with negative social stigma which affects all aspects of the sex workers' lives including healthcare, service providers and police. The stigma may result in increased stress, mental health problems, feelings of isolation and social exclusion. In the present study, 36 sex workers (SW) and 304 subjects from the general population in Israel (GP) were evaluated for the presence of bruxism and Temporomandibular disorders (TMD), with the use of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD- Axis I). When compared to the general population, sex workers presented larger maximal assisted mouth opening and higher prevalence of the following TMD diagnoses: Disc displacement with reduction, Myalgia, Myofascial pain with referral, Arthralgia (left and right) and Headache attributed to TMD. The odds of sex workers suffering from one of these diagnoses were twice to five times higher than those of the general population. The study shows that health problems of sex workers go beyond venereal diseases, HIV and mental disorders which are commonly studied. Oral health, TMD and oral parafunctions are some of the additional health issues that should be addressed and explored in this population.

Local myalgia compared to myofascial pain with referral according to the DC/TMD: Axis I and II results.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) categorized TMD muscle disorders into 3 subgroups: local myalgia, myofascial pain with spreading and myofascial pain with referral. However, the rationale for such division into subgroups and the pathogenesis and prognosis of muscle-related TMD are still poorly understood. The aim of this study was to explore the differences between local myalgia and myofascial pain with referral by means of a biopsychosocial model based on the DC/TMD. METHODS: This retrospective study included all consecutive TMD patients who were diagnosed according to the DC/TMD in our institution between 2015 and 2018. The Axis I and II findings of patients diagnosed with local myalgia were compared to those of patients with myofascial pain with referral. A p value < 0.05 was considered statistically significant. RESULTS: A total of 255 patients (61 men and 194 women, mean age 37.8 ± 15.34 years) were enrolled into the study, 114 in the local myalgia group and 83 in the myofascial pain with referral group. The levels of depression and nonspecific physical symptoms, headache attributed to TMD (HAattrTMD), and characteristic pain intensity (CPI) were significantly higher in the latter group. The significant differences for depression and nonspecific physical symptoms persisted after excluding patients diagnosed with HAattrTMD, however, the levels of significance were lower (p = 0.006 compared to p = 0.033 for depression total score, and p = 0.001 compared to p = 0.046 for nonspecific physical symptoms total score). CPI levels, extent of disability, and pain duration were similar for both groups when excluding for HAattrTMD. CONCLUSION: The current study findings highlight the importance of differentiating between subgroups of myalgia according to the DC/TMD. The diagnosis of myofascial pain with referral may point to a significant Axis II component.

Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era: A Sex Comparison among Dental Patients.

AIM: To evaluate the effect of the current coronavirus pandemic on the prevalence of bruxism, oral parafunctions and painful Temporo-Mandibular Disorders (TMDs) and to evaluate the influence of the pandemic on both sexes. METHODS: This retrospective study included 288 dental patients who underwent complete anamnesis and examination according to the Diagnostic Criteria for TMD. The study evaluated two patient populations according to the date of examination: (a) pre-COVID-19 pandemic era (108 patients); (b) COVID 19 pandemic era, where 180 patients were examined during the pandemic. RESULTS: A significant increase in parafunction activity was found in both men and women (p < 0.001) during the COVID-19 pandemic. Awake bruxism (AB) and sleep bruxism (SB) was more prevalent during the COVID-19 pandemic solely in women (AB-p < 0.001; SB-p = 0.014). CONCLUSIONS: Men and women were affected by the ongoing stress due to the COVID-19 pandemic, yet women showed a higher influence as compared to men. The long-term exposure to elevated levels of anxiety and stress may aggravate or trigger stomatognathic detrimental conditions. Dentists should be aware and regularly monitor their patients regarding the possible existence and consequences of bruxism and TMD.

Headache Attributed to Temporomandibular Disorders: Axis I and II Findings According to the Diagnostic Criteria for Temporomandibular Disorders.

AIMS: To analyze Axis I and II findings of patients diagnosed as having painful temporomandibular disorder (TMD) with headache attributed to TMD (HAattrTMD) in order to assess whether HAattrTMD is associated with a specific Axis I and II profile suggestive of the central sensitization process. METHODS: This retrospective study included 220 patients with painful TMD divided into those with (n = 60) and those without (n = 160) HAattrTMD, and the patients were compared for Axis I and II results according to the Diagnostic Criteria for TMD (DC/TMD). A P value < .05 was considered statistically significant. RESULTS: A total of 27.3% of the patients received a diagnosis of HAattrTMD. Myofascial pain with referral was significantly more common in the HAattrTMD group (P < .001), while local myalgia was significantly more common in the non-HAattrTMD group (P < .001). Characteristic pain intensity was significantly higher in the HAattrTMD group (P = .003), which also showed significantly higher levels of depression (P = .002), nonspecific physical symptoms (P = .004), graded chronic pain (P = .008), and pain catastrophizing (P = .013). Nonspecific physical symptoms were positively associated with HAattrTMD (odds ratio [OR] = 1.098, 95% CI = 1.006 to 1.200, P = .037). Local myalgia was negatively associated with HAattrTMD (OR = .295, 95% CI = 0.098 to 0.887, P = .030). CONCLUSIONS: Painful TMD patients who report headache in the temple area and are diagnosed as having local myalgia rather than myofascial pain with referral probably do not have HAattrTMD. The diagnosis of HAattrTMD may point to a central sensitization process and possible current/future chronic TMD conditions.

The effect of smartphones on daytime sleepiness, temporomandibular disorders, and bruxism among young adults.

OBJECTIVES: Effects of modern cellular technology on our lives is a relatively new topic of interest. The aim of the present study was to investigate the effect of smartphone use on daytime sleepiness, temporomandibular disorders (TMD), and bruxism (sleep and awake) among young adults in Israel. METHOD AND MATERIALS: Questionnaires on demographic variables, mobile phone use characteristics, anxiety, depression, daytime sleepiness, bruxism (sleep and awake), and diagnosis of TMD were filled in by ultra-Orthodox young adults (18 to 35 years of age) using a simple mobile device with no internet connection, religious young adults who use an internet-connected smartphone solely for work purposes, and secular young adults with an internet-connected smartphone for unlimited use. RESULTS: Various aspects of smartphone use, including being awakened at night by the phone, stress caused by information delivered by the phone, and stress from phone overuse increased the risks of daytime sleepiness, TMD, and bruxism. Those sequelae are associated with substantial negative effects on both the individual and society. High risks of motor vehicle accidents, chronic orofacial pain, and irreversible damage to hard dental tissue structures are some of those negative consequences. CONCLUSIONS: The adverse effects of smartphone use on daytime sleepiness, TMD, and bruxism are substantial. Their influence on public health and health care costs are causes of concern. (Quintessence Int 2021;52:548-559; doi: 10.3290/j.qi.b1244431).

Association between posterior crossbite and/or deep bite and temporomandibular disorders among Palestinian adolescents: A sex comparison.

Objective: To assess the prevalence of temporomandibular disorders (TMDs) and posterior crossbite and/or deep bite and any possible association between them. Methods: One thousand-nineteen adolescents responded to a questionnaire regarding oral habits and TMD symptoms. Afterwards, they were diagnosed according to the Axis I of the DC/TMD and underwent a dental examination. The chi-square test was used for statistical analysis. Results: A significant association  was found between posterior crossbite and some TMD diagnosis, but no association was found between deep bite and TMD, nor between occlusal diagnosis and bruxism. TMDs were more prevalent in girls. There was a significant sex difference (more among females) in the prevalence of painful TMDs. Conclusion: Posterior crossbite in the adolescent population analyzed may be related to TMDs, in contrary to deep-bite. The presence of posterior crossbite may have different impact on TMD findings between the sexes.

The prevalence of posterior crossbite, deep bite, and sleep or awake bruxism in temporomandibular disorder (TMD) patients compared to a non-TMD population: A retrospective study.

Objective: To assess the prevalence of posterior crossbite and/or deep bite among patients diagnosed with temporomandibular disorders (TMD) compared to a non-TMD population.Methods: Four hundred ninety-four patients were enrolled: 345 with TMD according to the diagnostic criteria for TMD and 149 without TMD (control group). The chi-square test was used for statistical analysis.Results: A statistically significant association was found between sleep and awake bruxism and painful TMDs (p < .001 for both), but not with disc displacement. There was no association between posterior crossbite and/or deep bite with either painful TMD or disc displacement.Conclusion: Within the study limitations, sleep bruxism and awake bruxism may be related to pain in the TMD, and the severity of a deep overbite and presence of a unilateral or bilateral posterior crossbite should not be considered risk factors or as having any effect on the pain associated with TMD and/or disc displacement.

Tinnitus in Temporomandibular Disorders: Axis I and Axis II Findings According to the Diagnostic Criteria for Temporomandibular Disorders.

AIMS: To examine the associations of self-reported presence of tinnitus with subtypes of temporomandibular disorders (TMD) as assessed by Axis I of the Diagnostic Criteria for TMD (DC/TMD) and with psychologic characteristics as assessed by Axis II. METHODS: This retrospective controlled study included 108 consecutive TMD patients referred to the Tel Aviv University Orofacial Pain Clinic. Each patient received full Axis I and Axis II diagnoses according to the DC/TMD. The patients were asked about currently experiencing tinnitus. Pearson chi-square test and Fisher exact test were used to test the associations between categorical variables. Mann-Whitney test was used to assess differences in continuous variables between categories. A P value < .05 was considered statistically significant. RESULTS: Thirty-three (30.6%) TMD patients reported experiencing tinnitus. There was a significantly higher prevalence of myofascial pain with referral (P = .008) and nonspecific physical symptoms (P = .014) among the TMD patients who reported tinnitus. In addition, those patients reported significantly longer pain duration compared to TMD patients without tinnitus (P = .039). CONCLUSION: This study emphasizes the necessity of assessing both Axes I and II according to the DC/TMD in future studies and supports creating a standardized tinnitus screener tailored to TMD patients for future studies on tinnitus in TMD patients.

Awake and Sleep Bruxism Among Israeli Adolescents.

Introduction: Sleep and awake bruxism are potential risk factors for oral hard tissue damage, failure of dental restorations and/or temporomandibular disorders. Identifying the determinants of sleep and awake bruxism among adolescents will enable development of preventive interventions for those at risk. Objectives: To determine emotional, behavioral and physiological associations of sleep and awake bruxism among Israeli adolescents. Methods: Two thousand nine hundred ninety-three Israeli high school students, from five different high schools in Israel, were approached in the classroom and requested to complete online questionnaires on sleep and awake bruxism, emotional aspects, smoking, alcohol consumption, oral habits, facial pain, and masticatory disturbances. The final study sample concerning awake and sleep bruxism included 2,347 participants. Results: 1,019 (43.4%) participants reported not experiencing any form of bruxism (neither sleep nor awake), 809 (34.5%) reported awake bruxism, 348 (14.8%) reported sleep bruxism and 171 (7.3%) reported both sleep and awake bruxism. Multivariate analyses (Generalized Linear Model with a binary logistic dependent variable) showed that one of the prominent variables affecting the occurrence of sleep bruxism was anxiety (mild, moderate and severe anxiety, Odds Ratios (OR) of 1.38, 2.08, and 2.35, respectively). Other variables associated with sleep bruxism were stress (each point in the stress scale increased the risk of SB by 3.2%), temporomandibular symptoms (OR = 2.17) and chewing difficulties (OR = 2.35). Neck pain showed a negative association (OR = 0.086). Multivariate analyses for awake bruxism showed an effect of moderate anxiety (OR = 1.6). Other variables associated with awake bruxism were stress (each point in stress scale increased the risk of AB by 3.3%), high and low levels of facial pain (OR = 2.94 and 1.53, respectively), creaks (OR = 1.85) and oral habits (OR = 1.36). Sleep bruxism was found to be a predictor for awake bruxism, and vice versa. In both cases ORs were 8.14. Conclusions: Among adolescents, sleep and awake bruxism are associated with emotional aspects as well as with facial pain symptoms and/or masticatory system disturbances. Awareness is recommended to decrease potential risks to teeth, dental restorations, and the masticatory system.

Potential orofacial hazards of resistance training: A controlled comparative study.

OBJECTIVE: To evaluate the effect of resistance training (RT) regarding potential hazard for dental wear, tooth abfractions, temporomandibular joint disc displacement, limitation in mouth opening, and existence of cervical spine disorders. The initial study hypothesis was that extensive resistance trainees (ExRT) would suffer from the above-mentioned symptoms more often than recreational trainees (RcT). METHODS: A controlled comparative study among male gym members via questionnaires and a clinical examination. RESULTS: ExRT had a higher prevalence of teeth indentations on the tongue (26% vs. 2% p < 0.001) and a higher prevalence of tooth abfractions than RcT (28% vs. 4% p < 0.005). ExRT exhibited a higher prevalence of cervical movement limitations (p < 0.05) and inadequate posture (p < 0.001). CONCLUSION: RT by itself may not be a risk factor for disc displacement. Nevertheless, it may act as a potential risk factor for irreversible hard tooth tissue damage and contribute to neck postural and mobility impairments.

Pain Catastrophizing and Pain Persistence in Temporomandibular Disorder Patients.

AIMS: To describe pain catastrophizing in temporomandibular disorder (TMD) patients in relation to disability and pain persistence. METHODS: A total of 163 TMD patients underwent a complete TMD evaluation according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), including the Pain Catastrophizing Scale (PCS). Patients were divided into subgroups according to their PCS, Graded Chronic Pain Scale (GCPS), and pain persistence scores. The GCPS and pain persistence subgroups were assigned as dependent variables in a stepwise multiple logistic regression model. The ability of the DC/TMD Axis II parameters and of the PCS to discriminate between patients of low and high disability (according to the GCPS) and low and high pain persistence were examined using area under the receiver operating characteristic (ROC) curve. α < .05 was considered to reflect statistical significance. RESULTS: Significant differences were found between high and low pain catastrophizing patients as to socioeconomic parameter, Axis I diagnoses, pain persistence, and Axis II evaluation. The parameters with significant discriminant ability for pain persistence were pain catastrophizing, depression, and nonspecific physical symptoms, with no significant differences between them. Depression increased the odds of high disability by 1.2, while pain catastrophizing increased the odds for high pain persistence more than 6-fold. Pain catastrophizing was not significantly associated with pain disability, and depression was not significantly associated with pain persistence. CONCLUSION: High-pain catastrophizing TMD patients were similar to patients with other chronic pain conditions, but differed from TMD patients as a group. The findings of this study support the addition of an assessment for pain catastrophizing to the DC/TMD for early identification of TMD patients who might be at higher risk for developing chronic pain.

Prevalence of bruxism and temporomandibular disorders among orphans in southeast Uganda: A gender and age comparison.

OBJECTIVES: The aims of the current study were: (1) to assess the prevalence of oral habits, bruxism, and temporomandibular disorders (TMDs) among children living in Uganda; (2) to establish whether parafunctional activities are associated with TMDs; and (3) to examine the possible impact of gender and age on the prevalence of bruxism, oral habits, and TMDs. METHODS: This study included 153 children aged 6-17 years. The study consisted of a questionnaire and a clinical examination. RESULTS: TMDs were moderately prevalent (35%). Parafunctional habits were performed by 93% of the participants. When performed extensively, they were significantly related to myalgia. No gender or age significant differences were found. CONCLUSIONS: 1. Only extensive masticatory parafunctional oral activity is significantly related to myalgia. 2. Gender and age had no impact on the prevalence of bruxism, oral habits, or TMDs. 3. Sleep and awake bruxism were not related to anamnestic symptoms or clinical findings in TMD.

Comparing Axis II Scores According to the RDC/TMD and DC/TMD in Israeli Patients.

AIMS: To use the Symptom Checklist-90-Revised (SCL-90-R)-based instruments of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the Primary Care Evaluation of Mental Disorders (PRIME-MD)-based instruments of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) in order to compare these Axis II scores in temporomandibular disorder (TMD) patients. METHODS: Demographic and socioeconomic data, Axis I diagnoses, and Axis II evaluations (depression, nonspecific physical symptoms, anxiety, and Graded Chronic Pain Scale [GCPS]) were compared between two groups of patients-142 TMD patients diagnosed according to the RDC/TMD (RDC group) and 157 TMD patients diagnosed according to the DC/TMD (DC group). Pearson's chi-square test, Fisher's exact test, and Mann-Whitney test were used, and P values were adjusted for multiple comparisons. RESULTS: The prevalences of severe depression, nonspecific physical symptoms, and anxiety were significantly lower in the DC group than in the RDC group, with no differences between groups for Axis I diagnoses, characteristic pain intensity (CPI), or GCPS. CONCLUSION: Within the limitations of this study, the present findings reveal differences in the presence of severe depression, nonspecific physical symptoms, and anxiety between the RDC and DC groups. The differences may reflect the cut-off scores of the SCL-90-R and the PRIME-MD tools.

Comorbidity between depression and anxiety in patients with temporomandibular disorders according to the research diagnostic criteria for temporomandibular disorders.

AIMS: To examine the extent of depression, anxiety, somatization, and comorbidity between depression and anxiety in patients with temporomandibular disorders (TMD) by adding the Symptom Checklist-90 Revised self-report questionnaire for anxiety to the Research Diagnostic Criteria for TMD. METHODS: A total of 207 Israeli TMD patients were included in this retrospective study. Data included levels of depression, anxiety, somatization, and comorbidity in the study group as a whole, in chronic pain TMD patients compared to acute pain TMD patients, and in chronic pain TMD patients according to their Graded Chronic Pain Scale score. Spearman correlation was used to assess the level of correlation between depression, anxiety, and somatization. Fisher exact test or Pearson chi-square test was used to compare the categorical variables. RESULTS: When depression, anxiety, somatization, and comorbidity were analyzed in a multidimensional approach, there were statistically significant differences between subgroups as to depression and somatization only. No statistically significant differences were found as to anxiety and comorbidity. CONCLUSION: Multidimensional assessment enabled differentiation between findings of depression, anxiety, somatization, and comorbidity in subgroups of TMD patients. The findings of no statistically significant differences between subgroups of TMD patients as to anxiety and comorbidity support previous studies on TMD and anxiety, which suggest a less significant role of anxiety in chronic TMD patients as compared to depression and somatization.