Objectives: The peak prevalence of temporomandibular disorders (TMDs) may occur in middle age. This study determined the proportion of matured adults seeking TMD treatment and compared their diagnostic, psychological and oral health-related quality-of-life (OHRQoL) profiles to younger patients. Methods: Adult subjects were recruited from a tertiary TMD centre and assigned to three age groups, namely 18-44 years (young adults [YA]), 45-64 (middle-aged adults [MA]) and ≥65 (old adults [OA]). TMD diagnoses were established with the Diagnostic Criteria for TMDs and categorised as pain-related (PT), intra-articular (IT) and combined (CT) TMDs. Psychological states and OHRQoL were assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Oral Health Impact Profile-TMDs (OHIP-TMDs). Demographic, DASS-21, and OHIP-TMDs data were analysed using chi-square test, one-way ANOVA and Pearson's correlation (P < .05). Results: Middle-aged (19.7%; 136/692) and old (4.0%; 28/692) adults comprised about a quarter of the TMD patients. Although gender distribution was comparable, significant differences in TMD categories were observed (P < .001). Pain-related TMDs were more prevalent in the MA/OA groups while intra-articular TMDs were more frequent in the YA group. No significant difference in DASS-21 and total OHIP scores was noted among three groups. However, the MA and OA groups had significantly lower OHRQoL in the physical pain domain. Correlations between DASS-21 and OHIP-TMDs scores varied with age and ranged from r s = 0.47-0.92. Conclusions: Matured patients constituted a quarter of TMD cohort and presented higher frequencies of painful TMDs. They have similar psychological profiles to younger patients but experienced lower OHRQoL in physical pain domain.

Background The Fonseca anamnestic index (FAI) offers a simple, low‐cost, patient‐reported method for screening temporomandibular disorders (TMDs). Objectives This study described the development of the Chinese version of the FAI (FAI‐C) and examined its reliability and validity when compared to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Methods The FAI‐C was created by translation and cross‐cultural adaptation of the English instrument following international guidelines. Psychometric evaluation of the FAI‐C was carried out on a sample of 613 patients with TMDs and 57 controls. Reliability of the FAI‐C was determined by means of internal consistency and test‐retest methods while validity was ascertained by criterion‐related validity. Criterion validity was examined via Cohen's kappa, sensitivity and specificity when compared with DC/TMD Axis I diagnoses. Results Cronbach's alpha value (internal consistency) for total FAI‐C score was 0.669, and intra‐class correlation coefficient (ICC) value (test‐retest reliability) was 0.823. For criterion validity, kappa coefficient value was 0.633 while sensitivity and specificity was 95.9% and 71.9%, respectively. Conclusion The Chinese version of the FAI demonstrated acceptable reliability and good validity. The FAI‐C could thus be used as an instrument for screening TMDs in Chinese literate populations.

Objectives To determine the differences in psychological states and sleep quality in patients with various temporomandibular disorder (TMD) subtypes, and to ascertain the relationships between TMD duration with psychological and sleep impairments. Methods A total of 830 TMD patients were recruited categorized into pain‐related (PT), intra‐articular (IT), and combined (CT) TMD groups. Each group was further divided into acute and chronic subtypes. The Depression, Anxiety, and Stress Scales‐21 (DASS‐21), and Pittsburgh Sleep Quality Index (PSQI) were used to assess emotional states and sleep problems. Results Although chronic TMDs generally had higher levels of anxiety, depression, stress, and sleep impairments than acute TMDs, significant differences were only observed for the PT group. Ranking of the mean depression, anxiety, and stress scores was as follows: acute TMDs: CT > PT > IT; chronic TMDs: PT > CT > IT. For both acute and chronic TMDs, the ranking of mean PSQI global and component scores was PT ≥ CT ≥ IT. Logistic regression analyses indicated that stress (ORs = 4.40) and depression (ORs = 2.82) increased the risks of chronic pain‐related TMDs (p < .05). Conclusions Chronic pain‐related TMDs are associated with high levels of psychological distress and poorer sleep, while chronic intra‐articular TMDs are not. Stress and depression increased the probability of chronic pain‐related TMDs.

Background: Studies on temporomandibular disorder (TMD) severity in patient populations are scarce.Objectives: This study sought to compare the psychological states and oral healthrelated quality of life (OHRQoL) among patients with differing TMD severity. Methods: Adult patients (≥18 years old) with and without (controls) TMDs were recruited from the TMD/oro-facial pain centre and prosthodontics department, respectively. The presence and severity of TMDs were established with the Fonseca Anamnestic Index (FAI), and TMD diagnoses were confirmed with the Diagnostic Criteria for TMDs (DC/TMD). Psychological states and OHRQoL were examined with the Depression, Anxiety, Stress Scales-21 (DASS-21) and Oral Health Impact Profile for TMDs (OHIP-TMD). Data were subjected to chi-square, Kruskal-Wallis/Mann-Whitney U tests and Spearman's correlation (α = .05).Results: A total of 961 participants with a mean age of 32.99 ± 13.14 years (71.19% women) were assessed. Frequencies of the various TMD categories were as follows:no TMD/controls (12.07%), mild TMD (24.56%), moderate TMD (40.37%) and severe TMD (23.00%). The three most common TMD-related symptoms were TMJ noises, mouth opening difficulty and muscle pain. Participants with moderate/severe TMD presented a higher proportion of intra-articular and/or combined disorders. They reported significantly higher levels of depression, anxiety, stress and poorer OHRQoL than their counterparts with no/mild TMD (p < .001). Moderate-to-strong correlations were observed between FAI and DASS-21/OHIP-TMD scores (rs = 0.42-0.72). Conclusions:Patients with moderate/severe TMD had significantly higher levels of psychological disturbance and poorer OHRQoL. As OHRQoL and psychological states are correlated, psychological well-being must be considered when managing patients with moderate/severe TMDs.

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