Distribution of anxiety and depression among different subtypes of temporomandibular disorder: A systematic review and meta‐analysis

Abstract

Background The evidence on the relationship between anxiety and depression and patients with distinct subtypes of temporomandibular disorder (TMD) is uncertain, so a thorough review study on the topic is still missing. Objectives This systematic review investigated the distribution and severity of anxiety and depression in patients diagnosed with different subtypes of TMD. Methods The study is registered in PROSPERO (CRD42020150562) and it followed the PRISMA 2020 Statement. We searched in PubMed, Web of Science, Scopus and SciELO databases (last search: 12 March 2021) and the reference list from the included studies. Study eligibility criteria consisted of: (i) patients diagnosed with TMD using the Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) instruments; (ii) assessment of anxiety and/or depression with validated psychological instruments and (iii) allocation of patients into a minimum of two distinct TMD subtypes with at least one group having myofascial pain (comparison group). Analyses were carried out using RevMan 5.3.5 statistical package and random‐ or fixed‐effects models (α = 0.05). The quality of evidence was assessed based on review authors' judgment derived from a 10‐item appraisal tool for prevalence studies and with the Newcastle–Ottawa scale. Results Of the 4086 records identified in total, 24 were eligible for inclusion; meta‐analyses were conducted with 20 studies. In total, 3678 subjects were included in the review. Most of the studies found that patients with myofascial pain showed similar occurrence and severity of anxiety/depression as compared to other subtypes of TMD, although the average prevalence seemed to be higher among the diagnoses consisting of myofascial pain (muscular TMD). Despite the moderate‐to‐high heterogeneity, anxiety and depression were more frequently distributed within patients with myofascial pain (p = .001). TMD patients without myofascial pain presented less severe levels of anxiety and depression than patients with only myofascial pain (p ≤ .01). The type of psychological instrument seems to affect the assessment of both anxiety and depression emotional states. Conclusion The findings of this review suggest that patients with myofascial pain are more anxious and more depressed than patients with other subtypes of TMD. Implications Considering that anxiety and depression are differently distributed within the TMD population, a proper assessment of the psychological state of patients seems essential to offer an adequate treatment and management of each specific subtype of TMD.

Association between temporomandibular disorders and anxiety: A systematic review

“…Previous systematic reviews have already revealed this positive association between TMD and psychosocial factors. Recently, Reis et al ( 18 ) demonstrated the relationship between distinct subtypes of TMD and anxiety and depression. These results suggest that patients with myofascial pain are more anxious and more depressed than patients with other subtypes of TMD, especially disc displacement or arthralgia/degenerative joint disease.…”

“…Recently, a systematic review ( 18 ) investigated whether there is a subtype of temporomandibular disorder that is more associated with the occurrence and severity of both anxiety and depression (together in the same patient) and the authors concluded that patients with myofascial pain are more anxious and depressed than others. In this way, it is clear how necessary to investigate separately biopsychosocial factors during the evaluation of TMD patients ( 5 , 14 ).…”

Protective Masks During the SARS-COV-2 Pandemic: Is there a Relationship with Temporomandibular Disorders? An Observational Cross-sectional Survey

“…This could explain the augmented pain in the joint area reported by people in the questionnaire. This research did not include other factors usually related to TMD such as psychological distress and sleep disturbances (22,23) as well as possible previously diagnosed structural and anatomical anomalies related to the TMJs (24,25) which may in uence the orofacial pain. Some limitations may still be linked to the online survey delivery.…”

CMD und Kieferorthopädie

“…Erkenntnisse über die Beziehung zwischen Angst und Depression und CMD zeigt eine aktuelle Studie, welche aufgrund einer Metaanalyse mit über 3500 Probanden zeigte, dass Patienten mit myofaszialen Schmerzen ängstlicher und depressiver sind als Patienten mit anderen Subtypen von CMD [22]. Grundsätzlich finden sich laut einem weiteren Übersichtsartikel klinisch signifikante Angstzustände und Depressionen bei Patienten mit chronischen Schmerzen im Gesichtsbereich [23].…”