The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents

Abstract

BackgroundTemporomandibular disorders (TMD) in children and adolescents is prevalent with pain as a common component, and has a comorbidity with psychosocial problems such as stress, depression, anxiety as well as somatic complaints. Therefore, the aim of the study was to investigate if psychosocial problems in children and adolescents are associated with TMD with pain (TMD-pain) and TMD without pain (TMD-painfree) when compared to children and adolescents without TMD.MethodsThis cross-sectional study consisted of 456 randomly selected children and adolescents, enrolled from 10 boy’s- and 10 girl’s- schools in Jeddah, between 10 and 18 years of age. On the examination day, prior to the clinical examination according to Research Diagnostic Criteria for TMD Axis I and II, the participants first answered two validated questions about TMD pain, and after that the Arabic version of the Youth Self Report scale. According to their clinical examination and diagnosis the participants were divided into three groups; non-TMD group, TMD-pain group, and TMD-painfree group.ResultsThe TMD-pain group presents a higher frequency of the internalizing problems anxiety, depression and somatic complaints than non-TMD group (p < 0.05). Regarding externalizing problems the only significant association found was for aggressive behavior in the TMD-pain group (p < 0.05). The TMD-pain group also shows a higher frequency of social problems than the non-TMD group. However, no such difference was found when compared to the TMD-painfree group. There was also a significant association with a higher frequency of thought problems in the TMD-pain group (p < 0.05). The children’s and adolescents’ physical activities were within border line clinical range for all three groups, whereas the social competence was within the normal range. There were no significant associations between any of the groups in this respect.ConclusionsTMD-pain in children and adolescents does not seem to affect the social activities. However, TMD-pain seem to have a strong association to emotional, behavior and somatic functioning, with higher frequencies of anxiety, depression, somatic problems, aggressive behavior and thought problems, than children and adolescents without TMD-pain. With respect to the biopsychosocial model the present study indicates that there are significant associations to psychosocial, somatic and behavioral comorbidities and TMD-pain in children and adolescents in the Middle East region.

Anxiety and malocclusion are associated with temporomandibular disorders in adolescents diagnosed by RDC/TMD. A cross‐sectional study

“…A possible explanation for the relation between TMD pain and anxiety might be due to the fact that anxiety exacerbates the masticatory muscle tension by clenching and grinding . This was also observed by Bertoli et al (2007), who found a significant difference in the signs and symptoms of TMD according to emotional status.…”

“…These diagnostic criteria have been used as gold standard for both children and adults, improving clinical TMD exam accuracy and reproducibility. However, the recently published Diagnostic Criteria for TMD (DC/TMD), are not yet validated for children neither for Portuguese language. Moreover, the conventional RDC/TMD criteria is the most acceptable and well‐known standard for diagnosing TMD in researches .…”

“…The aetiology of TMD has been considered to be one of the most controversial issues in clinical dentistry . The most acceptable theory regarding TMD aetiology is based on the biopsychosocial model with a biological disorder that may have psychological antecedents, such as anxiety and this situation exists in a social framework in adults …”

“…It is well known that psychosocial problems in children and adolescents are more frequent than in the past, and also that they are an association of mental disorders and physical diseases in adolescents with mental‐physical comorbidity . In adolescents, there is a positive correlation between increased age and the presence of signs and symptoms of TMD, so the emotional aspects seem to be significant factors in the presence of those disorders . Furthermore, there is a high prevalence of malocclusion in children and adolescents, which is considered a public health problem in the world and the third priority in oral care.…”

Association between temporomandibular disorders and pubertal development: A systematic review

“…Painful TMDs are often associated with psychosocial comorbidities. In addition to depression and somatic problems as reported by LeResche et al, adolescents with TMD pain may also have higher frequencies of anxiety, aggressive behaviour and thought problems than controls without temporomandibular pain …”