Risk factors associated with symptoms of temporomandibular disorders among women with hypermobile Ehlers-Danlos syndrome: Questionnaire-based study in Finland and Sweden.

BACKGROUND: Generalized joint hypermobility as a characteristic feature of Ehlers-Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD). OBJECTIVE: To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27- to 78-year-olds with diagnosed hypermobile EDS (hEDS). METHODS: A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio-demographic, general health and oral health-related factors, comorbid symptoms and psychological distress for self-reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables. RESULTS: Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27- to 50-year-olds participants were Finland as a country of birth, living alone and self-reported worst pain in the body (not the joints). The respective risk factors among the 51- to 78-year-olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives. CONCLUSIONS: Among adult women with confirmed hEDS, socio-demographic and health-related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected.

Accuracy of Dental Restorations Fabricated Using Milling vs 3D-Printed Molds: A Pilot Study.

PURPOSE: To compare the accuracy of 12 different dental restorations fabricated with milling or 3D-printed molds and robotically controlled casting. MATERIALS AND METHODS: Twelve dental restorations (11 inlays and onlays and 1 crown) were made per restoration type, one per each of the 12 different teeth models (total of 24 restorations). On each tooth preparation, two restorations were manufactured using different CAD/ CAM techniques: (1) milling and (2) robotically controlled casting and 3D-printed molds. In addition, twolayer restorations were manufactured with 3D-printed molds. The marginal and internal gaps were evaluated at 120 points per restoration based on micro-CT 3D imaging. Internal gaps were evaluated using a replica technique with silicone. RESULTS: Median values (interquartile ranges) for marginal gaps, middle internal gaps, and central internal gaps were significantly lower for 3D-printed mold restorations (44.3 [65.4] µm, 95.4 [96.2] µm, and 104.6 [78.1] µm) compared to milled restorations (58.4 [93] µm, 145.9 [85.8] µm, and 138.6 [65.7] µm). Internal gaps in the 3D-printed mold group were 6% to 51% smaller than in the milled group. CONCLUSIONS: The accuracy of restorations fabricated with 3D-printed molds may be preferable compared to milled restorations, except in the case of crown restoration. However, additional studies with a larger number of samples and different types of restorations are needed to confirm the results.

Autonomic Nervous System Activity and Dental Anxiety in the Northern Finland Birth Cohort (NFBC1966) Population.

Autonomic nervous system (ANS) activity may be associated with dental anxiety; however, no studies exist on the topic. The aim of this study was to assess if ANS activity and dental anxiety are associated. Data were collected as part of a Northern Finland Birth Cohort Study, NFBC1966, at the age of 46 years with eligible data on 1905 participants. Dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS) categorized as follows: 19-25 = high, 10-18 = moderate, 5-9 = no to low dental anxiety. Heart rate variability (HRV) data were collected using an HR monitor and a standard lead-II electrocardiogram (ECG). Baroreflex sensitivity (BRS) was calculated from continuous ECG and blood pressure signals. Participants were categorized into three groups as follows: Low = the lowest 20th percentile, Mid = medium 21-79th percentile, and High = the highest 20th percentile according to their ANS variables. The associations between the MDAS and ANS activity parameters were evaluated using unordered multinomial logit models adjusted for comorbidities, ß-blockers, BMI, smoking, and education. High heart rate, reduced HRV, low cardiac vagal modulation, and poor BRS were associated with moderate dental anxiety, and high cardiac vagal modulation and good BRS were associated with no to low dental anxiety. Poorer ANS activity might predispose some to dental anxiety, and better ANS activity might protect from dental anxiety.

Associations of inflammatory polyarthritis with clinical and radiological findings of temporomandibular disorders.

OBJECTIVE: To evaluate the association of different forms of inflammatory polyarthritis with clinical signs of temporomandibular disorders (TMD) and radiological findings in temporomandibular joint (TMJ), based on a nationwide health survey in Finland. The aim was also to assess the presence of clinical and radiological TMD findings in subjects with increased risk for developing rheumatoid arthritis (RA). MATERIAL AND METHODS: A nationally representative sample included 6331 Finnish adults who participated in the Health 2000 Survey (BRIF8901). Subjects were examined for signs of TMD, findings in panoramic radiograph of TMJ, musculoskeletal health and serology (rheumatoid factor, RF, and anti-cyclic citrullinated peptide, aCCP). RESULTS: Sixty-four percent of seronegative RA and 60% of seropositive RA subjects had at least one sign of TMD. While adjusting for confounding factors (gender, age, dentures and smoking history), RA was significantly associated with crepitation and abnormal radiological findings in TMJ. Seronegative RA was also associated with restricted mouth opening. Systemic autoimmunity associated with RA ("at risk of RA") was not associated with clinical or radiological TMD findings. CONCLUSIONS: Clinical and radiological findings of TMD are more prevalent among subjects with inflammatory polyarthritis than among the population in general in the Finnish adult population.

Repair bond strength of bulk-fill composites: influence of different primers and direction of debonding stress.

Background: The purpose of this in vitro study was to evaluate the effect of different adhesion primers on the repair bond strength of bulk-fill resin composite and short-term hydrolytic stability of the repair interface before and after accelerated aging. In addition, direction of debonding stress was examined. Materials and methods: Bulk-fill substrates were aged in water for 14 days at 37 °C. Smooth resin composite surfaces were prepared for the substrates with a superfine grinding paper (FEPA #500, #1200, #2000). Test specimens were produced by attaching bulk-fill composite to the substrate surfaces, using three different primer/bonding systems. Specimens were aged 24 h at 37 °C in water, or thermal cycled (5-55 °C/5,000 cycles). Subsequently, shear bond strength and micro-tensile bond strength were evaluated. In total there were 60 specimens for the shear bond strength and 60 specimens for the micro-tensile bond strength measurements (30 stored in water 24 h, 30 thermal cycled, n = 10 in each primer/bonding mode). Results: The mean shear bond strength was 9.1-13.1 MPa after 24 h water storage and 6.9-10.7 MPa after thermal cycling. The mean micro-tensile bond strength was 28.7-45.8 MPa after 24 h water storage and 22.7-37.9 MPa after thermal cycling. Conclusion: The Ceramic primer (silane containing) seems to perform better than the three-step etch and rinse adhesive or the Composite primer. Shear-type stress had an adverse effect on the repair bond strength of bulk-fill resin composites.

Associations between pain-related temporomandibular disorders and dental anxiety at 46 years of age in the Northern Finland Birth Cohort 1966.

OBJECTIVES: The aims were (1) to study the association between dental anxiety (DA) and temporomandibular disorders (TMDs) and whether subgroups formed differ in psychological symptoms and pain sensitivity in the Northern Finland Birth Cohort 1966 and (2) to confirm the factor structure of the Hopkins Symptom Checklist-25 assessing psychological symptoms. MATERIALS AND METHODS: Data were acquired using questionnaires and clinical examinations at age 46 years (n = 1889). Dental anxiety was assessed with Modified Dental Anxiety Scale (MDAS). Pain-related TMD (myalgia, arthralgia) were assessed according to modified diagnostic criteria for temporomandibular disorders. Pressure pain threshold and tolerance were measured with an algometer. Explanatory factor analysis revealed three factors, named 'depression', 'anxiety' and 'distress'. RESULTS: Those with high DA and myalgia and/or arthralgia reported higher depression (mean = 1.52), anxiety (mean = 1.61) and distress (mean = 2.06) scores, and lower pressure pain threshold (mean = 496 kPa) and tolerance (mean = 741 kPa) values than those with only DA (1.22; 1.56; 1.84; 613; 875), TMD (1.21; 1.39; 1.83; 600; 908) or neither (1.12; 1.29; 1.58; 707; 1006), respectively. CONCLUSIONS: Patients with DA and/or myalgia/arthralgia have similar profiles regarding pain sensitivity and psychological symptoms, the burden being highest among those with DA and a TMD diagnosis.

The relation of temporomandibular disorders with oral health-related quality of life in the Northern Finland Birth Cohort 1966.

OBJECTIVE: This study aimed to evaluate the association between temporomandibular disorders (TMD) and oral health-related quality of life (OHRQoL) in an adult population. METHODS: The data included 1,768 adults 46 years of age in the Northern Finland Birth Cohort 1966 (NFBC1966) study. The symptoms, signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and validated questionnaires. OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Associations of TMD and OHRQoL were evaluated with χ2 -test and Fisher's exact test. RESULTS: In females, pain-related TMD signs and diagnoses associated significantly with prevalence of OHIP total and all dimensions, whereas in joint-related TMD, psychological dimensions showed the strongest association. Males with pain- or joint-related TMD, the most impaired dimension was physical pain. CONCLUSION: Pain-related TMD seems to associate more strongly with lower OHRQoL than joint-related TMD especially in females.

Association of health-related factors with self-reported sleep and awake bruxism in Northern Finland Birth Cohort 1966 - a cross-sectional study.

OBJECTIVE: The study aimed to investigate the association of sleep bruxism (SB) and awake bruxism (AB) with health-related factors. METHODS: Data on bruxism and diagnosed diseases, use of psychoactive substances and regular identified psychoactive drugs were collected from 1,962 subjects in the Northern Finland Birth Cohort 1966 through a questionnaire. The associations were analyzed using chi-square tests and binary regression models, adjusting for gender and education, and for anxiety/depression symptoms. RESULTS: Migraine and gastric/duodenal disorders, use of serotonergic antidepressants and a high number of psychoactive drugs associated significantly with AB and SB. Gastrointestinal diseases associated with SB. Poor general health and hand eczema associated with AB. Based on the multivariate model, depression/anxiety symptoms seemed to mediate the associations of bruxism with depression, hand eczema, self-reported gastric/duodenal disorders and the number of identified drugs. CONCLUSION: Several diseases, depression/anxiety symptoms and psychoactive medications were associated with SB and AB, the associations being stronger with AB than SB.

The role of pain-related disability on treatment outcome and psychosocial symptoms in patients with temporomandibular disorders - a pilot study.

OBJECTIVE: The aim of the pilot study was to investigate the association of pain-related disability with the outcome of conservative treatment of temporomandibular disorders (TMD) and with depressive and non-specific physical symptoms among TMD pain patients utilizing Graded Chronic Pain Scale 1.0 (GCPS1.0) as a screening instrument. MATERIAL AND METHODS: The study included 80 adult patients who were referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, due to TMD pain. At baseline, pain-related disability was assessed by using the GCPS1.0 according to the Research Diagnostic Criteria for TMD (RDC/TMD), and the patients were categorized into three TMD subtypes, 1-3. Patients were given conservative TMD treatment. At follow-up visits (1, 3, 6, and 12 months), patients evaluated the pain intensity on an NRS and described the treatment outcome and the severity of the TMD symptoms on a numerical scale. RESULTS AND CONCLUSIONS: Patients with TMD subtype 3 (moderate/severe disability) had the highest NRS scores and described their symptoms as most severe at each time point, statistically significantly so at 1-month and 6-month follow-up (p < .05). The highest proportion of depressive symptoms was found in TMD subtype 3 (p < .05). The current pilot study showed that moderate/severe TMD-related disability, based on the GCPS 1.0 as a screening tool, may be linked with poor treatment outcome and depressive symptoms. Studies with larger samples are needed to confirm the results.

Association between cynical hostility and temporomandibular pain mediated through somatization and depression: an 11-year follow-up study on Finnish adults.

BACKGROUND: Hostility is believed to have an adverse effect on physical health through mediating psychosocial factors. OBJECTIVES: This study aimed to investigate the association of hostility with temporomandibular (TMD) pain. Another aim was to investigate if the association is mediated through increases in depressiveness and somatization in an 11-year follow-up on Finnish adults, based on the Health 2000 and 2011 Surveys (BRIF8901). MATERIAL AND METHODS: The sample comprised subjects who underwent clinical TMD pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TMD pain symptoms in 2011. Hostility was measured using the Cynical Distrust Scale, somatization was measured using the Symptom Checklist-90, and depressiveness using Beck's Depression Inventory-21. Four subgroups were formed based on the presence of TMD pain: no pain, pain in 2000 only, pain in 2011 only, and pain in 2000 and 2011. Analyses included chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hostility in 2000 as the predictor. Mediation analysis was performed using Hayes' Process v3.5. RESULTS: Those with higher hostility showed a higher prevalence of TMD pain. Longitudinally, the association of hostility with TMD pain in 2000 only, and with TMD pain in both years, was mediated either by somatization only or by depressiveness that was mediated by somatization. In those with TMD pain in 2011 only, the association was mediated by depressiveness that was mediated by somatization. CONCLUSION: Hostility increased the risk of TMD pain through increases in depressiveness and somatization.

Association of self-reported bruxism with temporomandibular disorders - Northern Finland Birth Cohort (NFBC) 1966 study.

OBJECTIVE: To investigate the prevalence of self-reported bruxism and its association with temporomandibular disorders (TMD). The hypothesis of the study was that self-reported bruxism is associated with TMD. METHODS: The data were gathered from 1962 subjects who participated in a field study in 2012-2013, including a questionnaire concerning bruxism and TMD symptoms as well as clinical sub-diagnoses of TMD using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Statistical method was chi-square test. Bonferroni correction was made, and a p-value of <0.003 was considered as significant. RESULTS: The prevalence of self-reported bruxism was 39.6%: 34.0% in men and 44.5% in women. Those who reported sleep bruxism (SB) or awake bruxism (AB) had significantly more pain-related TMD symptoms and signs compared to those not reporting bruxism. CONCLUSION: The prevalence of self-reported bruxism is high among middle-aged adults and is associated with TMD pain-related symptoms and signs, as well as TMD diagnoses.

Prevalence of sagittal molar and canine relationships, asymmetries and midline shift in relation to temporomandibular disorders (TMD) in a Finnish adult population.

OBJECTIVE: To examine the prevalence of sagittal relationships, asymmetries and midline shift, and their associations with temporomandibular disorders (TMD) in the Northern Finland Birth Cohort 1966 (NFBC1966). MATERIALS AND METHODS: 1845 subjects participated in a clinical examination at the age of 46. Occlusal measurements were performed using 3D models. Symptoms of TMD were screened using validated questions, and signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and questionnaires. Associations between variables of occlusion and TMD were evaluated with χ2-test and Fisher's exact test and using logistic regression analyses, adjusted for self-reported general health, mental health, bruxism, and rheumatoid arthritis. RESULTS: The most common sagittal relationships were Class I and normal canine relationship. Half-cusp Class II and post-normal canine relationship were more frequent in females, and Class III and pre-normal canine relationship in males. Deviations from normal cuspid or molar relationships showed a weak but statistically significant association with TMD, especially in females. Half-cusp Class II and Class II relationships were more frequent in relation to joint-related TMD signs and diagnoses while missing canines were associated with pain-related TMD diagnoses. CONCLUSIONS: The present study findings gave some indications that canine relationships are associated with pain-related TMD, whereas Angle II sagittal occlusal relations may associate with joint-related TMD. Occlusal characteristics should therefore be taken into account as one possible associating factor in subjects with TMD.

Occlusal characteristics in facial pain cases and controls - 12-year follow-up of the Northern Finland Birth Cohort (NFBC) 1966.

Objective: The purpose of this study was to investigate the occlusal characteristics in Finnish adults at 12-year follow-up based on the Northern Finland Birth Cohort 1966 (NFBC1966) subjects.Methods: The occlusal analyses were performed at ages 34 and 46 years of facial pain cases (n = 52) and controls (n = 49) by two different methods.Results: At 12-year follow-up, a significant decrease in upper anterior segment peer assessment rating (PAR) score was found in the controls, indicating improvement in teeth alignment. In facial pain cases, left lateral occlusal relationship and midline asymmetry were significantly decreased. Occlusal asymmetry and overjet were significantly increased. In controls, the left canine showed a more normal occlusal relationship, cuspid asymmetry was changed, and midline asymmetry was significantly decreased.Conclusion: During a 2-year period, occlusal asymmetry and overjet increased significantly in facial pain cases, while occlusal relationship showed more normal characteristics in controls.

Sleep problems in pain patients entering tertiary pain care: the role of pain-related anxiety, medication use, self-reported diseases, and sleep disorders.

ABSTRACT: Chronic pain and sleep problems frequently co-occur. Pain itself disturbs sleep, but other factors may also contribute to sleep problems in pain patients. This cross-sectional study of 473 patients (69.9% female, mean age 47 years) entering tertiary pain management compared normally sleeping pain patients with those having recurring sleep problems to determine the relationship between pain and sleep. Groups were compared for pain and pain aetiology, pain-related anxiety, childhood adversities, use of sleep and pain medications, self-reported diseases, and sleep disorders. Furthermore, the association of pain-related anxiety (cognitive anxiety, escape/avoidance, fear, and physiological anxiety) with more disturbing sleep problems was investigated in the whole cohort. The main results were that those with sleep problems more often reported multiple health conditions than those sleeping normally (depression 31.6% vs 5.0%; angina pectoris 6.5% vs 0.0%; asthma 19.6% vs 1.7%; low back problems 55.1% vs 23.3%; joint disease other than rheumatoid arthritis 32.3% vs 18.3%). Accumulations of 5 or more childhood adversities were more often present in those with sleep problems. Restless legs symptoms were more common in those with sleep problems than those sleeping normally (33.2% vs 11.7%). Patients having sleep problems reported more use of sleep and pain medications than those sleeping normally. Findings about pain-related anxiety suggest physiological reactions as significant factors for increased sleep disturbances. These factors need to be addressed in the management of the comorbidity of pain and sleep problems, and research to understand mechanisms in these is sorely needed.

Association of temporomandibular disorders with pain sensitivity: A cohort study.

BACKGROUND: Pain related to temporomandibular disorders (TMD) can be linked with multiple site pain (MSP), and may associate with increased pain sensitivity, more frequently among women than men. The aim of the study was to examine the associations of pressure pain threshold (PPT) and tolerance (PPTo) with TMD and associated MSP in the Northern Finland Birth Cohort 1966 (NFBC1966) study. METHODS: Altogether 1961 NFBC1966 subjects attended clinical medical and dental examination at the Institute of Dentistry, University of Oulu in 2012-2013. Clinical examinations were carried out using a modified Diagnostic Criteria for TMD protocol (DC/TMD). MSP was defined based on questions regarding body pain sites. Additionally, PPT and PPTo were assessed using algometer measurements. Mann-Whitney U-test and Tobit regression models were used to analyse associations between TMD sub-diagnoses, MSP, PPT and PPTo, stratified by sex. Further models were adjusted with anxiety and depressive symptoms, which were assessed using Hopkins Symptom Checklist-25 (HSCL-25) and two-way interaction terms. RESULTS: Among females, lower PPT and PPTo were associated with myalgia and arthralgia. Among males, lower PPT and PPTo were associated with MSP-linked TMD. Tobit regression analysis showed significantly lower PPT and PPTo values in the myalgia and arthralgia subgroups among female TMD subjects. Among females, disc displacement with reduction had an inverse association with PPT and PPTo. Among males, lower PPTo was associated with degenerative joint disease and MSP-linked TMD. CONCLUSIONS: The pain regulatory mechanisms behind TMD act differently between the genders as local TMD among females and MSP-linked TMD among males were associated with pain sensitivity. SIGNIFICANCE: The study shows that there are differences in the associations of painful TMD with pressure pain tolerance, pressure pain sensitivity and MSP between male and female subjects.

Comparison of Axis II psychosocial assessment methods of RDC/TMD and DC/TMD as part of DC/TMD-FIN phase II validation studies in tertiary care Finnish TMD pain patients.

BACKGROUND: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and Diagnostic Criteria for TMD (DC/TMD) include Axis II instruments for psychosocial assessment. OBJECTIVES: The aims were to compare the Finnish versions of Axis II psychosocial assessment methods of the RDC/TMD and DC/TMD and to study their internal reliability. METHODS: The sample comprised 197 tertiary care referral TMD pain patients. The associations between RDC/TMD [Graded Chronic Pain Scale (GCPS) 1.0, Symptom Check List 90-revised (SCL-90R)] and DC/TMD (GCPS 2.0, Patient Health Questionnaire-9 (PHQ-9), PHQ-15) assessment instruments were evaluated using Spearman correlation coefficients, Wilcoxon Signed Rank s, chi-squared test and gamma statistics. The internal reliability and internal inter-item consistency of SCL-90-R, PHQ-9, PHQ-15 and Generalized Anxiety Disorder-7 (GAD-7) were evaluated using Cronbach's alpha coefficient values. RESULTS: The DC/TMD and RDC/TMD Axis II psychosocial instruments correlated strongly (p < .001). GCPS 1.0 and GCPS 2.0 grades were similarly distributed based on both criteria. The RDC/TMD psychological instruments had a higher tendency to subclassify patients with more severe symptoms of depression and non-specific physical symptoms compared to DC/TMD. The internal reliability and internal inter-item consistency were high for the psychological assessment instruments. CONCLUSION: The Finnish versions of the RDC/TMD and DC/TMD Axis II psychosocial instruments correlated strongly among tertiary care TMD pain patients. Furthermore, the Axis II psychological assessment instruments indicated high validity and internal inter-item consistency and are applicable in Finnish TMD pain patients as part of other comprehensive specialist level assessments, but further psychometric and cut-off evaluations are still needed.

Association of psychological distress and widespread pain with sympatoms of temporomandibular disorders and self-reported bruxism in students.

OBJECTIVES: The aim of this study was to evaluate the association of psychosocial distress and widespread pain with self-reported symptoms of temporomandibular disorders (TMD) and bruxism, in two cross-sectional surveys in 2012 and 2016, and whether there are temporal changes in the magnitude of associations. MATERIALS AND METHODS: The data were gathered from Finnish university students in 2012 and 2016. TMD symptoms were assessed with three validated questions and bruxism with one frequently used question. Psychosocial distress was assessed with the General Health Questionnaire-12 (GHQ-12), and widespread pain with questions of pain in the extremities, the neck or upper back, and lower back. The associations of GHQ-12, widespread pain and background variables with TMD symptoms and bruxism were analyzed with chi-square tests, t-test and binary logistic regression models stratified by gender, and adjusted for age-group, self-reported general health/wellbeing and presence of widespread pain. RESULTS: Higher GHQ-12 score and presence of widespread pain were significantly associated with TMD symptoms in both genders at both time points. The association of higher GHQ-12 score with sleep bruxism and awake bruxism were inconsistent. In the adjusted model higher GHQ-12 score and widespread pain were significantly related to TMD pain symptoms in both genders at both time points, and to bruxism in 2012. Between the two time points a greater variability in these associations was seen in men than in women. CONCLUSIONS: Psychological distress and widespread pain are significant determinants in perceived TMD pain and bruxism among students. No significant temporal alterations were observed.

Low-grade inflammation as a potential mediator between depressive symptoms and temporomandibular pain: an 11-year follow-up study on Finnish adults.

BACKGROUND: Low-grade inflammation and depressiveness have been associated with chronic pain conditions. OBJECTIVE: To examine whether low-grade inflammation mediates the association between depressive symptoms and temporomandibular (TM) pain in Finnish adults based on the Health 2000/2011 Surveys (BRIF8901). METHODS: The sample comprised subjects who underwent clinical TM pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TM pain symptoms in 2011. The serum level of hs-CRP was obtained in both years, and depressiveness was assessed using the Beck Depression Inventory-21 (BDI-21) in 2000 and BDI-13 in 2011. Four subgroups were formed based on the presence of TM pain: No pain, pain in 2000-only, pain in the 2011-only, and pain in both-years. Analyses included Rao Scott's chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hs-CRP and BDI-21 score in 2000 as predictors. Mediation was tested using Hayes A. Processv3.5. RESULTS: Higher BDI-21/-13 and hs-CRP levels corresponded to higher prevalences of TM pain in both years. Longitudinally, in men, higher hs-CRP level predicted TM pain in 2000-only and TM pain in both-years. Higher BDI-21 score predicted having TM pain in 2011-only. In women, higher BDI-21 score predicted TM pain in 2000-only and having TM pain in both-years. Both BDI-21 and hs-CRP had a direct effect on TM pain outcome with no mediation detected. CONCLUSION: While depressiveness may increase the risk of chronic TM pain in women, the risk in men is increased by low-grade inflammation.

Association of Temporomandibular Disorder Symptoms with Physical Fitness among Finnish Conscripts.

Studies on the role of physical fitness, physical activity and obesity as risk factors for temporomandibular disorders (TMD) are scarce. The aim of the present study was to evaluate the association of TMD symptoms with physical fitness, physical activity and body mass index (BMI) among Finnish conscripts. The study sample consisted of 8685 Finnish conscripts. Data on self-reported TMD symptoms were used as outcome variables. Physical activity (questionnaire), physical fitness (measured with physical tests: Cooper test, push-ups, sit-ups and standing long jump) and body mass index (BMI) were used as explanatory variables. The associations between TMD symptoms and explanatory variables were evaluated using Chi-squared test and logistic regression analysis. The prevalence of all TMD symptoms was significantly higher among those who exercised more rarely than weekly. Pain-related TMD symptoms were also significantly more frequent among those who were overweight (BMI ≥ 25). Poor push-up results and overweight (BMI ≥ 25) were significantly associated with jaw pain and TMJ pain at jaw rest. The present study showed that good physical fitness may be a protective factor against TMD pain. Dentists should also be prepared to motivate TMD patients to physical activity and regular exercise as part of the treatment.

Importance of the Graded Chronic Pain Scale as a Biopsychosocial Screening Instrument in TMD Pain Patient Subtyping.

AIMS: To compare the suitability of Graded Chronic Pain Scale (GCPS) pain intensity and interference assessments (GCPS version 1.0 vs 2.0) for the biopsychosocial screening and subtyping of Finnish tertiary care referral patients with TMD pain. METHODS: Altogether, 197 TMD pain patients participated in this study. All patients received Axis II specialist-level psychosocial questionnaires from the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD-FIN) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD-FIN), as well as questionnaires for the assessment of additional pain-related, biopsychosocial, and treatment-related variables. Clinical examinations were performed according to the DC/TMD Axis I protocol. The patients were categorized into TMD subtypes 1, 2, and 3 (GCPS I and II-low; II-high; and III and IV, respectively) based on their biopsychosocial profiles according to GCPS versions 1.0 and 2.0. RESULTS: The distribution of TMD pain patients into TMD subtypes was similar according to the GCPS 1.0 compared to the GCPS 2.0. Over 50% of the patients were moderately (TMD subtype 2) or severely (TMD subtype 3) compromised. Patients in subtype 3 experienced biopsychosocial symptoms and reported previous health care visits significantly more often than patients in subtypes 1 and 2. Patients in subtype 2 reported intermediate biopsychosocial burden compared to subtypes 1 and 3. CONCLUSION: TMD pain patients differ in their biopsychosocial profiles, and, similarly to the GCPS 1.0, the GCPS 2.0 is a suitable instrument for categorizing TMD tertiary care pain patients into three biopsychosocially relevant TMD subtypes. The GCPS 2.0 can be regarded as a suitable initial screening tool for adjunct personalized or comprehensive multidisciplinary assessment.